Vaughan Tanner on micro-incision cataract surgery with multifocal lenses


(mellow music) – Cataract is still the commonest cause of blindness worldwide,
fortunately not in the UK or in most of the Western
world where cataract surgery has gone through enormous advances in the last 15 to 20
years, allowing us now to remove cataracts safely from
the vast majority of people. Most cataract surgery is carried out when patients notice visual problems, usually blur but also glare,
halos off headlights at night, and sometimes difficulty with
glasses and contact lenses such that the visual
quality really is very poor and is only really correctable by addressing the lens within the eye rather than correction outside the eye. Many people ask about anaesthetic. Majority of cases are now carried out under a local anaesthetic, majority of those under anaesthetic drops, so-called topical anaesthetic,
which allows the patient to have a very quick rapid recovery usually with a white eye and no injections or cuts on the surface. Topical anaesthetic isn’t
suitable for everyone and if patients are particularly nervous or really unable to lie
still during the procedure, then they can have the option of an injection around the eye, a so-called sub-Tenon’s anaesthetic, or a general anaesthetic if
patients really are nervous and want to have a bit more relaxation during that procedure. Surgery itself is carried out through the clear part
of the eye, the cornea, making some very small incisions, again, usually bloodless,
so no need for suturing. Modern technology allows us to bring the incision size down
to around two millimetres. And that just allows us to
not only take the cataract out but also to insert a new
replacement lens within the eye. A lot of research and development has gone into intraocular lenses over the last five to 10 years and we’re now able in about 95% of people to accurately not only
remove their cataracts safely but also get them out
of distance spectacles post-operatively, which is
often very much appreciated. Technology has now moved
on and in those patients with astigmatism, we can now also make additional cuts on
the surface of the eye or introduce what is called
a toric intraocular lens, and this has additional
power within the lens, allowing us to correct for
distance glasses again, not only for those patients who are short-sighted or long-sighted but also allowing us to
correct for their astigmatism. These multifocal lenses
come in various styles and aim to reduce either
intermediate glasses use for computers and dashboards, near glasses use for small print, or a combination of all three, being distance, intermediate, and near. The more we try and achieve
with the intraocular lens the greater compromise
there is on optical quality. Of course everyone’s slightly different and we need to have an in-depth
discussion with each patient regards exactly the type of
lens that they may require. Okay, so here we have a model eye. Front of the eye is the cornea, the clear area through
which the patient sees, and of course through
which the surgeon sees to do the procedure. If we look inside the
eye you will see the lens sitting behind the
iris, behind the cornea. It is of course the lens which becomes cataractous
in old age, usually. And this is where we have
to address our surgery and where the artificial implant will sit once the natural lens is taken out. Clear corneal incisions are made just in front of the white of the eye. Pupil is widely dilated,
allowing surgical access. Patient of course lies on their back in the operating theatre, allowing me to look down into the eye
to carry out the procedure. Usually we use ultrasound
power to break up the lens. This is still generally considered the gold standard for cataract removal rather than laser surgery, although both are now
increasingly being used. Having removed the lens
from inside the eye by emulsifying it out through
a two-millimeter incision on the eye, we then inject a lens which unfolds behind the iris and sits inside the
remaining capsular bag here. This of course allows
focusing of light rays coming through the cornea,
through the artificial lens, and onto the retina at
the back of the eye. Majority of patients have a very quick pain-free recovery and are able to return to normal
activities including driving usually within about a week of surgery. (mellow music)

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