Advances in cataract surgery


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Perfect Vision's Dr Con Moshegov presentation on: Advances in cataract surgery

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  • As we get older, we lose contrast sensitivity, first at the higher spatial frequencies, then for all the spatial frequencies. Our patients need regular checkups that include contrast sensitivity testing to monitor and assess the changes in their vision.
  • MESSAGE: We used the NDS system designed by Dr. Ginsburg. This system was validated against detection and identification distances from published Dept. of Transportation Data. Ginsburg A, Kelly M; Functional vision testing: night driving simulator studies (1995) ASCRS ASOA Symposium of Cataract, IOL and Refractive Surgery, San Diego, California, April 1-5, 1995.
  • Advances in cataract surgery

    1. 1. Con Moshegov FRANZCO, FRACS Con Moshegov FRANZCO, FRACS Ophthalmologist Advances in Cataract Surgery
    2. 3. Cataract is an opacification of the lens
    3. 8. Acanthamoeba infection
    4. 10. The cataract comes out in one whole piece
    5. 12. Limitations of ECCE <ul><li>Prolonged surgery time </li></ul><ul><li>Trauma leads to inflammation </li></ul><ul><li>Suture distortion of cornea </li></ul><ul><li>Prolonged convalescence </li></ul><ul><li>Restrictions to activity </li></ul><ul><li>Necessitates a regional ‘block’ anaesthetic </li></ul>
    6. 13. The cataract is emulsified then sucked out
    7. 14. Phacoemulsification
    8. 15. Phacoemulsification
    9. 16. Phacoemulsification
    10. 17. <ul><li>Phacoemulsification </li></ul><ul><li>Small incision (2.75 to 3.25mm) </li></ul><ul><li>Can be performed without needles </li></ul><ul><li>Takes only minutes </li></ul><ul><li>Less inflammation </li></ul><ul><li>Faster recovery </li></ul><ul><li>Little restriction to activity </li></ul>
    11. 18. Aqualase <ul><li>Lens liquifaction device </li></ul><ul><ul><li>Alcon Infiniti </li></ul></ul><ul><ul><li>Also has ultrasonic </li></ul></ul><ul><ul><li>phacoemulsification </li></ul></ul>
    12. 20. Aqualase <ul><li>4 microlitre bursts of water </li></ul><ul><li>No heat </li></ul><ul><li>Soft plastic tip </li></ul><ul><li>Advantages: </li></ul><ul><ul><li>No heat at wound, no wound burns </li></ul></ul><ul><ul><li>Less endothelial cell disruption </li></ul></ul><ul><ul><li>Less risk of posterior capsular rupture </li></ul></ul><ul><li>Disadvantages: </li></ul><ul><ul><li>Expensive </li></ul></ul><ul><ul><li>Too slow for hard cataracts </li></ul></ul>
    13. 21. Intraocular lenses (IOLs) 6mm
    14. 22. Small incision surgery <ul><li>How do you get the IOL in? </li></ul>
    15. 24. Folding and Insertion of a lens
    16. 25. Advances in IOL technology
    17. 26. Acrysof Natural
    18. 27. Contrast Sensitivity is a better test of functional vision than Visual Acuity!
    19. 28. Sinewave contrast sensitivity is the most widely accepted test of contrast sensitivity
    20. 29. Contrast Sensitivity Decreases with Age
    21. 30. Simulated Image Contrast Enhancement by Aspheric Correction “ Aspheric IOLs emulate the young crystalline lens, whose negative spherical aberration tends to compensate positive spherical aberration of the cornea.”
    22. 31. Aspheric IOLs
    23. 32. Night driving problems related to aberrations
    24. 33. Night Driving Simulator <ul><li>Long straight street </li></ul><ul><li>Simulated speed 35 miles/h </li></ul><ul><li>High degree of ambient light </li></ul><ul><li>Long straight road </li></ul><ul><li>Simulated speed 55 miles/h </li></ul><ul><li>Minimum ambient light (low beam auto headlights) </li></ul>City Driving Scene Rural Driving Scene <ul><ul><li>Target detection and identification </li></ul></ul>
    25. 34. Night Driving Simulation <ul><li>With Tecnis ™ and at 55 mph, patients identify a pedestrian (rural setting/glare) at 486 feet versus 441 feet for the standard IOL (p=0.0011) </li></ul><ul><li> Increased reaction time  Safer stopping </li></ul>
    26. 35. Perfect Vision <ul><li>‘ Killing two birds at the same time’ </li></ul>
    27. 36. Perfect Vision
    28. 37. Short-sightedness
    29. 38. Long-Sightedness
    30. 39. Astigmatism
    31. 40. Refractive errors <ul><li>All of these prevent clear vision without the use of glasses. </li></ul><ul><li>Cataract surgery is increasingly used to reduce peoples dependence on glasses </li></ul><ul><li>If not combined with refractive surgery it would be unwise to promise patients the ability to see perfectly well without glasses </li></ul>
    32. 41. Pre op Biometry Ultrasound IOL Master: coherence interferometry
    33. 42. Cornea too steep
    34. 43. Secondary LASIK
    35. 44. Reading without glasses <ul><li>Aim for myopia in both eyes </li></ul><ul><li>Aim for myopia in one eye (monovision) </li></ul><ul><li>Multifocal IOL </li></ul>
    36. 45. Accomodating IOLs
    37. 46. Principle of a Refractive Multifocal IOL
    38. 47. Principle of a Diffractive Multifocal IOL <ul><li>Addition of refractive lens </li></ul><ul><li>causes light to converge to </li></ul><ul><li>two points </li></ul>
    39. 48. ReSTOR pseudoaccomodating IOL
    40. 49. Alcon ReSTOR IOL
    41. 50. Alcon ReSTOR IOL
    42. 51. New Intraocular lenses <ul><li>However: </li></ul><ul><li>Still requires careful patient selection </li></ul><ul><li>Optimal distance for reading is short </li></ul><ul><li>Best for hypermetropes with presbyopia </li></ul><ul><ul><li>Unaided distance acuity < 6/18 </li></ul></ul><ul><li>Must control astigmatism </li></ul>
    43. 52. Presbyopia
    44. 53. The procedure in practice <ul><li>Almost all done on a ‘day only’ basis </li></ul><ul><li>Hospital or day surgery </li></ul><ul><li>(FBC, EUC, ECG, CXR, INR ) </li></ul><ul><li>IVI (or oral) sedation </li></ul><ul><li>Topical anaesthesia </li></ul>
    45. 54. The procedure in practice <ul><li>Post op visits on day 1, possibly one week and a month </li></ul><ul><li>Topical corticosteroid, antibiotic and possibly a NSAID </li></ul><ul><li>Eye shield at night </li></ul><ul><li>Abstain from swimming and makeup </li></ul><ul><li>Timing of surgery for second eye is variable </li></ul>
    46. 55. Myth <ul><li>My cataract was removed with a laser </li></ul>
    47. 56. Myth <ul><li>They had to take my eye out to remove the cataract and then they put it back again </li></ul>
    48. 57. Myth <ul><li>My aunt’s cataract had to be removed a second time </li></ul>
    49. 58. Conclusion <ul><li>Cataract surgery is one of the most commonly performed operations in Australia </li></ul><ul><li>It has a very high success rate </li></ul><ul><li>Developments have taken place to make it even safer, faster, more accurate and, in some cases, able to free people from a dependence on glasses. </li></ul>