Cataracts and Cataract Surgery Surendra Basti, MD Surendra Basti, MD LASIK, Cataract & Cornea Surgeon LASIK, Cataract & Cornea Surgeon Associate Professor.

Cataracts and Cataract Cataracts and Cataract SurgerySurgery

Surendra Basti, MDSurendra Basti, MD

LASIK, Cataract & Cornea SurgeonLASIK, Cataract & Cornea Surgeon Associate Professor of OphthalmologyAssociate Professor of Ophthalmology

Northwestern University Feinberg School of Northwestern University Feinberg School of Medicine, Chicago, ILMedicine, Chicago, IL

Email: [email protected]: [email protected]

What is a Cataract ?What is a Cataract ?

Definition:Definition: Degradation of the Degradation of the optical quality of the optical quality of the crystalline lens through loss crystalline lens through loss of clarity or change in color of clarity or change in color

Discoloration or opacification Discoloration or opacification of the human lensof the human lens

The Crystalline LensThe Crystalline Lens

The LensThe Lens

All light going into the eye needs All light going into the eye needs to pass through lensto pass through lens

Important role in focusing of light. Important role in focusing of light.

Change in color or clarity of lens Change in color or clarity of lens changes light focusing and hence changes light focusing and hence affects vision clarityaffects vision clarity

Cataract – Age of Cataract – Age of OnsetOnset

Age related (senile)Age related (senile) – most common – most common

Cataracts in young adultsCataracts in young adults – inherited, – inherited, secondary to trauma, electric shock, secondary to trauma, electric shock, radiation, diabetes, medication-radiation, diabetes, medication-related, myopia, chronic eye disease related, myopia, chronic eye disease or surgeryor surgery

Cataracts in childrenCataracts in children – metabolic, – metabolic, anatomic abnormalities, inheritedanatomic abnormalities, inherited

Age Related Cataract – Age Related Cataract – Causative FactorsCausative Factors

AgeAge

DiabetesDiabetes

Environmental: UV-B light, Environmental: UV-B light, smokingsmoking

Advanced CataractAdvanced Cataract


Age related (senile) – most commonAge related (senile) – most common

Cataracts in childrenCataracts in children – metabolic, – metabolic, anatomic abnormalities, inheritedanatomic abnormalities, inherited

Cataracts in young adults – inherited, Cataracts in young adults – inherited, secondary to trauma, electric shock, secondary to trauma, electric shock, radiation, diabetes, medication-radiation, diabetes, medication-related, myopia, chronic eye disease related, myopia, chronic eye disease or surgeryor surgery

Subluxed Lens – Subluxed Lens – MarfanMarfan’’s Syndromes Syndrome

Uveitic CataractUveitic Cataract Photos of chelationPhotos of chelation

Cataract in Juvenile Rheumatoid Arthritis

Cataract in Juvenile Rheumatoid Arthritis


Age related (senile) – most commonAge related (senile) – most common

Cataracts in children – metabolic, Cataracts in children – metabolic, anatomic abnormalities, inheritedanatomic abnormalities, inherited

Cataracts in young adultsCataracts in young adults – inherited, – inherited, secondary to trauma, electric shock, secondary to trauma, electric shock, radiation, diabetes, medication-radiation, diabetes, medication-related, myopia, chronic eye disease related, myopia, chronic eye disease or surgeryor surgery

Cataract – Causative Cataract – Causative FactorsFactors

Medication relatedMedication related: inhaled or : inhaled or oral oral

steroid intake, phenothiazinessteroid intake, phenothiazines

Cataract – Causative Cataract – Causative FactorsFactors

Systemic disease –Systemic disease –myotonic myotonic dystrophy, dystrophy, WilsonWilson’’s disease, s disease, Atopic dermatitis, Atopic dermatitis, diabetes, diabetes, neurofibromatosineurofibromatosiss

Cataract and DiabetesCataract and Diabetes

Two patterns of cataract formationTwo patterns of cataract formation

Most common is cataract formation Most common is cataract formation that is of insidious onset (late 50s)that is of insidious onset (late 50s)

Less frequently, uncontrolled Less frequently, uncontrolled diabetes causes acute onset of diabetes causes acute onset of cataractcataract



Cataract – Can it be Cataract – Can it be Prevented or Slowed ?Prevented or Slowed ?

No definitive proof that intake of No definitive proof that intake of vitamins or nutrients or vitamins or nutrients or ‘‘catalinacatalina’’ eyedrops decrease incidence of eyedrops decrease incidence of cataractcataract

Anatomic Types of Anatomic Types of Cataract & Their Visual Cataract & Their Visual ImplicationsImplications


Nuclear Cataract - Nuclear Cataract -

Posterior Subcapsular CataractPosterior Subcapsular Cataract

CorticalCortical

Anatomic Types of Anatomic Types of CataractCataract



CorticalCortical


Nuclear CataractNuclear Cataract - -

Change in vision clarity andChange in vision clarity and

eyeglass prescription for distanceeyeglass prescription for distance


Nuclear CataractNuclear Cataract


CorticalCortical



Decreased vision especially in Decreased vision especially in

Bright light, glareBright light, glare




CorticalCortical


Cortical CataractCortical Cataract – –

minimally affects clarity minimally affects clarity

of vision unless advanced.of vision unless advanced.

Common symptom is Common symptom is

glareglare

Treatment StrategiesTreatment Strategies

When cataract mild, a change in When cataract mild, a change in eyeglasses helps visioneyeglasses helps vision

In patients with more advanced In patients with more advanced cataracts or in patients with cataracts or in patients with glare, surgical treatment is glare, surgical treatment is indicatedindicated

Cataract SurgeryCataract Surgery

Most commonly performed eye surgeryMost commonly performed eye surgery

Among most successful surgeries that Among most successful surgeries that can be performed on the human body. can be performed on the human body. Not a procedure without risk.Not a procedure without risk.

Topical Anesthesia, out-patient Topical Anesthesia, out-patient procedureprocedure


Steps – remove cataract and place Steps – remove cataract and place an artificial lens in place of it. an artificial lens in place of it.


Steps – remove cataract and place Steps – remove cataract and place an artificial lens in place of it. an artificial lens in place of it.

6.06.0mmmm

13.013.0mmmm

Cataract Surgery VideoCataract Surgery Video

Cataract Surgery – Cataract Surgery – Postop. PeriodPostop. Period

Topical steroid eyedrops for 4 weeksTopical steroid eyedrops for 4 weeks

Topical antibiotic for a weekTopical antibiotic for a week

Eyeglass check in 4 weeksEyeglass check in 4 weeks

Thereafter, yearly follow-upThereafter, yearly follow-up

Do Cataracts Come Do Cataracts Come Back ?Back ?

NO !NO !

After Cataract (Posterior After Cataract (Posterior Capsule Opacification)Capsule Opacification)

Alternative Locations for Artificial Lens – Anterior Chamber IOL

Alternate Location for Alternate Location for IOL – Sutured IOLIOL – Sutured IOL PhotosPhotos

Recent Advances in Recent Advances in Cataract SurgeryCataract Surgery Cataract Surgery may be looked upon Cataract Surgery may be looked upon

as an opportunity to give patients as an opportunity to give patients freedom from eyeglassesfreedom from eyeglasses

This is possible with the use of newer This is possible with the use of newer IOLs that focus light at most distancesIOLs that focus light at most distances

(these lenses are (these lenses are multifocalmultifocal as as opposed to previous lenses which are opposed to previous lenses which are monofocalmonofocal))

Multiple zones permit focusing at distance and near distances

Recent Advances in Recent Advances in Cataract SurgeryCataract Surgery New IOLs have an out-of-pocket cost New IOLs have an out-of-pocket cost

similar to LASIK surgerysimilar to LASIK surgery

Considerable freedom from eyeglasses Considerable freedom from eyeglasses possible with these IOLspossible with these IOLs

Some surgeons/patients extend the Some surgeons/patients extend the above to patients who donabove to patients who don’’t have a t have a cataract but want freedom from reading cataract but want freedom from reading glasses (Refractive Lens Exchange)glasses (Refractive Lens Exchange)

Cataract Surgery and Cataract Surgery and AlphablockersAlphablockers

Alpha blockers cause pupil to behave Alpha blockers cause pupil to behave unpredictably (does not dilate, floppy unpredictably (does not dilate, floppy iris) during surgeryiris) during surgery

Selective blockers (tamulosin, Rapaflo)Selective blockers (tamulosin, Rapaflo) have a more profound effecthave a more profound effect

5 alpha reductase inhibitors (avodart, 5 alpha reductase inhibitors (avodart, proscar) do not affect the pupilproscar) do not affect the pupil

Cataract Surgery and Cataract Surgery and AlphablockersAlphablockers

Instruct patients to intimate their Instruct patients to intimate their eye doctor if they are having eye doctor if they are having cataract surgerycataract surgery

Stopping alphablockers prior to Stopping alphablockers prior to surgery does not prevent IFISsurgery does not prevent IFIS

Dose or duration of use do not Dose or duration of use do not have a significant effect of IFIShave a significant effect of IFIS

Cataract - SummaryCataract - Summary

Cataract is a major cause for Cataract is a major cause for treatable vision deficittreatable vision deficit

Acute onset of cataract usually Acute onset of cataract usually not age related – diabetes, not age related – diabetes, trauma possible causestrauma possible causes


Cataract Surgery only when Cataract Surgery only when patient bothered by existing patient bothered by existing visionvision

Cataract surgery among most Cataract surgery among most successful surgical procedures successful surgical procedures but is not without riskbut is not without risk


Cataract surgery is an outpatient Cataract surgery is an outpatient procedure done using local procedure done using local anesthesia and involves removal anesthesia and involves removal of cataract with Ultrasound and of cataract with Ultrasound and placement of IOLplacement of IOL

For patients desiring freedom For patients desiring freedom from eyeglasses, options of new from eyeglasses, options of new IOLs availableIOLs available

THANK YOU

FREQUENCYFREQUENCYFREQUENCYFREQUENCY

Frequency

WHAT IS IT?•How fast the phaco needle moves back and forth

WHAT IS THE FREQUENCY RANGE?•The frequency of ultrasonic handpieces is between 27,000 and 60,000 times per second

ASPIRATION FLOW RATEASPIRATION FLOW RATEASPIRATION FLOW RATEASPIRATION FLOW RATE

It is the primary force that attracts It is the primary force that attracts material to the phaco tipmaterial to the phaco tip

• It determines how fast material is drawn to the phaco tip

High Flow

Low Flow

Cataracts and Cataract Surgery Surendra Basti, MD Surendra Basti, MD LASIK, Cataract & Cornea Surgeon LASIK, Cataract & Cornea Surgeon Associate Professor.

Documents

inherited slide

surgery slide

inherited cataracts

crystalline lens slide

advanced cataract slide

human lens slide

surgery cataracts

smoking slide