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Dr. Mazhry
Spectacle independence Spectacle independence after Cataract Surgeryafter Cataract Surgery
Dr. Zia-Ul-MazhryFCPS(Pak), FRCS(Edin), FRCS(Glasgow), CIC Ophth- (UK)
Discussion Plan
Dr. Mazhry
Objectives:
Upon successful completion of the activity, participants will be able to: Understand the magnitude of reversible
blindness caused by cataract and ideal time for surgical intervention.
Review the basics of phaco cataract and IOL surgery
Apply information, while advising their peers and family about the latest aphakic visual rehabilitation and spectacle independence after phaco cataract IOL surgery
Dr. Mazhry
THE BASICSPart-1
The Blindness Burden
In Pakistan, according to the Pakistan National Blindness and Impairment survey, the leading causeof blindness in adults more
than 30 years of age is cataract (Table 4). While globally 39.1% of all blindness is
attributable to cataract, in Pakistan the burden of blindness due to cataract is significantly larger at 51.5%. 85.4% of blindness is avoidable in Pakistan.
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When Should an Individual Have Cataract Surgery?
Need to get rid of old concept of “A cataract does not have to become "ripe" before it can
be removed” It is time to consider cataract surgery
if an individual has a cataract and resultant blurred vision that makes it difficult to do anything he or she wants and needs to do,.
A cataract should not be removed simply because: it is present. Many people have cataracts that do not
cause blurred vision, interfere with activities of daily living.
Dr. Mazhry
Eye as an optical system
Focusing Lenses Cornea
• Fixed power 43D Lens
• Variable power 10-20D
Axial Length Fixed 22-24mm
The image formation
The image Processing
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The Lens and Cataract
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Presbyopia
The Astigmatism
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THE STORIESPart-2
Dr. Mazhry FRCS, FCPS
21st century IOLs
Cataract Story1500 years BC to 21st Century & Beyond
Dr. Mazhry FRCS, FCPS
21st century IOLs
The Story of IOL
Sir Harold Ridley performed first IOL implantation on November 29, 1949.
– long-standing dogma that one "should never put a foreign body into the delicate tissues of the eye“
The Phaco story
Phacoemulsification was first introduced in 1967 1969 “Charlie has produced an
operation which will take all the fun out of cataract surgery.”
1974 “The use of the phaco machine for the removal of a cataractous lens is analogous to the shooting of game birds with guided missiles.”
Evolution of Phaco
The 1960s – The Beginning
The 1970s – Moving Back
The 1980s – The Capsulorrhexis Era
From 1985 to 1995- a “dramatic phaco revolution” The less than 10% of
surgeons using phaco in the early 1980s rocketed to 95% by 1995.
The 2000s – An Era of Alternative Energies and Further Reduction of
Ultrasound EnergyCataract & Refractive Surgery Today
Story of foldable IOLs
.
OCULAR SURGERY NEWS 6/1/2007
Erin L. Boyle
“I longed for a method of IOL insertion
that would not require me to
enlarge the [phaco] wound.”
Thomas R Mosacco MD
The AcrySof Story
علم توحیدی میں ھاتھوں دل لبریز سے عشققدم تھے چومے کے بڑھ نے ہسپانیہ ساحلگئی ہو خلافت قائم آ2خرش میں قرطبہگئی ہو روشن بھی میں یورپ 2سلام ِع: شمتھا معمور قرطبہ سے تہذیب 2ور علمکا نور منب: 2یک لئے کے یورپ تاریکتیرگی چھائی پہ یورپ تھی 2ند2م بر لرزہروشنی گل گئی ہو ہاتھوں کے ہی پاسبانوں
سرور و رقص و نغمہ رباب و طاؤس و چنگفتور کا آ2پس 2ور دوری سے حکموں کے 2للہگو کلمہ سب گئے 2ٹھ سے و2دیوں کی ہسپانیہہو 2للہ صد2ئے آ2ئی پھر نہ تک صدیوں کتنیسو2 کے 2للہ 2یک نہیں غالب بھی کوئیبجا جا کندہ تحریر ہے پہ 2لحمر2ء دیو2رگلہ سے قدرت تیری یا کروں سے ضعیفی 2پنیکا تثلیث کدہ ظلمت میں وسط کے حرم تیرےسجود و جڈب کا 2قبال بہت آ2یا تو یاددرود ویسا ٰووۃ صل ویسی ہو بھی میں قسمت میریجلے دل کا مظہری پہ بربادیوں تیری 2ندلس
ملے موسی و طارق کو ساحdلوں تیرے نہ پھر
2ندلس د2ستان
CHOOSING AN IOL (INTRA OCULAR LENS)
Part-3
Choosing an IOL
Surgeon’ View The Lens
• Material• Design• Cost
The Procedure• Wound Size• Easy, Safe, Quick,
Insertion Post Op
• Visual Outcome• Inflammation• PCO• Dysphotopsia
Patient Factors Motivation Life Style Different Models
and Makes? Cost Cost Cost
Cataract Surgery
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Monfocal Lenses
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The Ideal Foldable IOL
Smaller Incisions Surgeon friendly implantation
Durable and flexible Compatible delivery system
Centration & Fixation in Capsular Bag Excellent visual out come No Inflammatory response No PCO Spectacle Independence
Foldable IOL Materials
Silicone Acrylic
Hydrophylic(Hydrogel) Hydrophobic
Collamer
Choosing an IOL?
Choosing an IOL-The Material
Silicone Acrylic
Hydrophylic(Hydrogel) Hydrophobic
Collamer
Choosing an IOL-The Insertion Systems
ForcepsInjection SystemsInjection Systems
Dr. Mazhry FRCS, FCPS
21st century IOLs
Choosing an IOL-The Insertion Systems
SPECTACLE INDEPENDENCE AFTER CATARACT SURGERY
Part-5
Multifocal Lenses
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Lenses WITH CORRECTIONS
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WHAT WE DO AT WTHC EYE DEPARTMENT
Part-4
Why to talk and explain the technology to the patients?
It is important because the decision is going to affect the rest of the life of the patent.
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Guidelines for Ocular Implants and disposables
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The patients are admitted one day before the surgery. The power of the lens is calculated through biometric
measurements. A briefing is already given to the patient about
availability and non reimbursable nature of lens Implants.
Standard Intraocular lens combining quality with economy in accordance with the approximate amount, (patient happily and easily agrees to spend) is prescribed mentioning power model and make.
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However no patient is refused surgery or lens implant on the basis that he or she cannot afford to purchase. Such patients are provided implant from mutual Zakat Fund from the staff.
The patients are advised to purchase the implant on their own. They are guided about the nearby places for purchasing according to their choice and convenience.
The patients are advised to arrange required medicine and material. They get it checked by the staff and the patients keep it in their own custody till the time of their surgery.
The patient brings the implant and disposables with him or her to OT on operation day. After surgery and implantation the lens stickers are pasted in the patient record and the lens card with details and sticker pasted on it is also handed over to the patient.
Phacoemulsification Procedure
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AcrySof Restore IOL Implantation
What’s Ahead
Preloaded Lenses Multi-focal Lenses Thin Lenses Phakic Lenses Adjustable Lenses Accommodating Lenses Injectable IOLs Toric Lenses Custom Lenses
21st century IOLs
Light Adjustable IOLs
OVERVIEW AND SUMMARYPart-5
Dr. Mazhry
The Whole The Whole PackagePackage
Rapid, Safe, Smooth Two Handed Surgery with time tested lens implant aiming at true
spectacle independence
Dr. Mazhry
Lay sans bhi ahista keh nazuk hai buht kamAfaq ki is kargah – e -shisha gari ka