Cataracts and Cataract Surgery Surendra Basti, MD Surendra Basti, MD LASIK, Cataract & Cornea Surgeon LASIK, Cataract & Cornea Surgeon Associate Professor of Ophthalmology Associate Professor of Ophthalmology Northwestern University Feinberg School of Medicine, Chicago, IL Northwestern University Feinberg School of Medicine, Chicago, IL

What is a Cataract ? Definition: Degradation of the optical quality of the crystalline lens through loss of clarity or change in color Definition: Degradation of the optical quality of the crystalline lens through loss of clarity or change in color Discoloration or opacification of the human lens Discoloration or opacification of the human lens

The Crystalline Lens

The Lens All light going into the eye needs to pass through lens All light going into the eye needs to pass through lens Important role in focusing of light. Important role in focusing of light. Change in color or clarity of lens changes light focusing and hence affects vision clarity Change in color or clarity of lens changes light focusing and hence affects vision clarity

Cataract – Age of Onset Age related (senile) – most common Age related (senile) – most common Cataracts in young adults – inherited, secondary to trauma, electric shock, radiation, diabetes, medication-related, myopia, chronic eye disease or surgery Cataracts in young adults – inherited, secondary to trauma, electric shock, radiation, diabetes, medication-related, myopia, chronic eye disease or surgery Cataracts in children – metabolic, anatomic abnormalities, inherited Cataracts in children – metabolic, anatomic abnormalities, inherited

Age Related Cataract – Causative Factors Age Age Diabetes Diabetes Environmental: UV-B light, smoking Environmental: UV-B light, smoking

Advanced Cataract

Cataract – Age of Onset Age related (senile) – most common Age related (senile) – most common Cataracts in children – metabolic, anatomic abnormalities, inherited Cataracts in children – metabolic, anatomic abnormalities, inherited Cataracts in young adults – inherited, secondary to trauma, electric shock, radiation, diabetes, medication-related, myopia, chronic eye disease or surgery Cataracts in young adults – inherited, secondary to trauma, electric shock, radiation, diabetes, medication-related, myopia, chronic eye disease or surgery

Subluxed Lens – Marfan’s Syndrome

Uveitic Cataract Photos of chelation Photos of chelation Cataract in Juvenile Rheumatoid Arthritis

Cataract – Age of Onset Age related (senile) – most common Age related (senile) – most common Cataracts in children – metabolic, anatomic abnormalities, inherited Cataracts in children – metabolic, anatomic abnormalities, inherited Cataracts in young adults – inherited, secondary to trauma, electric shock, radiation, diabetes, medication-related, myopia, chronic eye disease or surgery Cataracts in young adults – inherited, secondary to trauma, electric shock, radiation, diabetes, medication-related, myopia, chronic eye disease or surgery

Cataract – Causative Factors Medication related: inhaled or oral Medication related: inhaled or oral steroid intake, phenothiazines

Cataract – Causative Factors Systemic disease – myotonic dystrophy, Wilson’s disease, Atopic dermatitis, diabetes, neurofibromatosis

Cataract and Diabetes Two patterns of cataract formation Two patterns of cataract formation Most common is cataract formation that is of insidious onset (late 50s) Most common is cataract formation that is of insidious onset (late 50s) Less frequently, uncontrolled diabetes causes acute onset of cataract Less frequently, uncontrolled diabetes causes acute onset of cataract

Cataract and Diabetes

Cataract – Can it be Prevented or Slowed ? No definitive proof that intake of vitamins or nutrients or ‘catalina’ eyedrops decrease incidence of cataract No definitive proof that intake of vitamins or nutrients or ‘catalina’ eyedrops decrease incidence of cataract

Anatomic Types of Cataract & Their Visual Implications

Nuclear Cataract - Nuclear Cataract - Posterior Subcapsular Cataract Posterior Subcapsular Cataract Cortical Cortical

Anatomic Types of Cataract Nuclear Cataract - Nuclear Cataract - Posterior Subcapsular Cataract Posterior Subcapsular Cataract Cortical Cortical

Anatomic Types of Cataract & Their Visual Implications Nuclear Cataract - Nuclear Cataract - Change in vision clarity and eyeglass prescription for distance

Anatomic Types of Cataract Nuclear Cataract Nuclear Cataract Posterior Subcapsular Cataract Posterior Subcapsular Cataract Cortical Cortical

Anatomic Types of Cataract & Their Visual Implications Posterior Subcapsular Cataract Posterior Subcapsular Cataract Decreased vision especially in Bright light, glare

Anatomic Types of Cataract Nuclear Cataract - Nuclear Cataract - Posterior Subcapsular Cataract Posterior Subcapsular Cataract Cortical Cortical

Anatomic Types of Cataract & Their Visual Implications Cortical Cataract – minimally affects clarity of vision unless advanced. Common symptom is glare

Treatment Strategies When cataract mild, a change in eyeglasses helps vision When cataract mild, a change in eyeglasses helps vision In patients with more advanced cataracts or in patients with glare, surgical treatment is indicated In patients with more advanced cataracts or in patients with glare, surgical treatment is indicated

Cataract Surgery Most commonly performed eye surgery Most commonly performed eye surgery Among most successful surgeries that can be performed on the human body. Not a procedure without risk. Among most successful surgeries that can be performed on the human body. Not a procedure without risk. Topical Anesthesia, out-patient procedure Topical Anesthesia, out-patient procedure

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

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

6.0 mm 13.0 mm

Cataract Surgery Video

Cataract Surgery – Postop. Period Topical steroid eyedrops for 4 weeks Topical steroid eyedrops for 4 weeks Topical antibiotic for a week Topical antibiotic for a week Eyeglass check in 4 weeks Eyeglass check in 4 weeks Thereafter, yearly follow-up Thereafter, yearly follow-up

Do Cataracts Come Back ? NO ! NO !

After Cataract (Posterior Capsule Opacification)

Alternative Locations for Artificial Lens – Anterior Chamber IOL

Alternate Location for IOL – Sutured IOL Photos Photos

Recent Advances in Cataract Surgery Cataract Surgery may be looked upon as an opportunity to give patients freedom from eyeglasses Cataract Surgery may be looked upon as an opportunity to give patients freedom from eyeglasses This is possible with the use of newer IOLs that focus light at most distances This is possible with the use of newer IOLs that focus light at most distances (these lenses are multifocal as opposed to previous lenses which are monofocal) (these lenses are multifocal as opposed to previous lenses which are monofocal)

Multiple zones permit focusing at distance and near distances

Recent Advances in Cataract Surgery New IOLs have an out-of-pocket cost similar to LASIK surgery New IOLs have an out-of-pocket cost similar to LASIK surgery Considerable freedom from eyeglasses possible with these IOLs Considerable freedom from eyeglasses possible with these IOLs Some surgeons/patients extend the above to patients who don’t have a cataract but want freedom from reading glasses (Refractive Lens Exchange) Some surgeons/patients extend the above to patients who don’t have a cataract but want freedom from reading glasses (Refractive Lens Exchange)

Cataract Surgery and Alphablockers Alpha blockers cause pupil to behave unpredictably (does not dilate, floppy iris) during surgery Alpha blockers cause pupil to behave unpredictably (does not dilate, floppy iris) during surgery Selective blockers (tamulosin, Rapaflo) Selective blockers (tamulosin, Rapaflo) have a more profound effect have a more profound effect 5 alpha reductase inhibitors (avodart, proscar) do not affect the pupil

Cataract Surgery and Alphablockers Instruct patients to intimate their eye doctor if they are having cataract surgery Instruct patients to intimate their eye doctor if they are having cataract surgery Stopping alphablockers prior to surgery does not prevent IFIS Stopping alphablockers prior to surgery does not prevent IFIS Dose or duration of use do not have a significant effect of IFIS Dose or duration of use do not have a significant effect of IFIS

Cataract - Summary Cataract is a major cause for treatable vision deficit Cataract is a major cause for treatable vision deficit Acute onset of cataract usually not age related – diabetes, trauma possible causes Acute onset of cataract usually not age related – diabetes, trauma possible causes

Cataract - Summary Cataract Surgery only when patient bothered by existing vision Cataract Surgery only when patient bothered by existing vision Cataract surgery among most successful surgical procedures but is not without risk Cataract surgery among most successful surgical procedures but is not without risk

Cataract - Summary Cataract surgery is an outpatient procedure done using local anesthesia and involves removal of cataract with Ultrasound and placement of IOL Cataract surgery is an outpatient procedure done using local anesthesia and involves removal of cataract with Ultrasound and placement of IOL For patients desiring freedom from eyeglasses, options of new IOLs available For patients desiring freedom from eyeglasses, options of new IOLs available

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FREQUENCYFREQUENCY 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 RATE It is the primary force that attracts material to the phaco tip It is the primary force that attracts material to the phaco tip It determines how fast material is drawn to the phaco tip High Flow Low Flow