Category: Cataract Surgery

Elective Surgery May Be Cancelled

Post author By Randall Wong, M.D.
Post date March 24, 2020

As the pandemic spreads, elective surgery and routine office visits are being cancelled or postponed.

How will this affect ophthalmologists, optometrists and you?

For eye doctors, the American Academy of Ophthalmology recommends that we stop office visits for “routine” eye care: as examples, routine follow ups, glasses prescription, etc.

The AAO is recommending that ophthalmologists restrict office hours to those patients with urgent and emergent conditions. An example would be sudden loss of vision, pain or retinal detachment.

Contact your own doctor to determine if you should keep a pre-existing appointment or if you are having questions or concerns about your own vision.

Surgery May be Cancelled

The American Hospital Association and the Centers for Disease Control and Prevention (CDC) have recommended elective and non-urgent surgical procedures be cancelled or postponed. As of this writing, there is no national mandate, but do check with your doctor if you are or were planning to have surgery.

What is elective surgery? Examples include hip and knee replacements, plastic surgery and, even, cataract surgery.

Not all eye surgery would be cancelled. As a retina specialist, I’ll be cancelling surgeries for epiretinal membranes and macular holes, but will need to continue emergency surgery for retinal detachments.

Preserve Healthcare Resources

Why are we restricting patient care and cancelling surgery?

The goal of limiting patient care in our offices is to reduce the chances of healthy people becoming exposed to the virus. It is an effort to protect patients, office staff and healthcare providers. It allows patients with active problems to receive care during this crisis.

The postponement of elective surgical procedures also reduces exposure of healthy individuals, but also preserves valuable and limited healthcare resources. For instance, cancellation of elective surgery preserves hospital beds and staff for those who may have significant illness and need care. As an example, our outpatient surgical center can now send our nurses and aides to the main hospital and ER where they may be needed.

Keep in mind that patients will still need chemotherapy, suffer heart attacks and strokes, sustain accidents in addition to contracting coronavirus.

Both these measures will aid in “flattening the curve.”

Tags Coronavirus, COVID-19

Cataract Cataract Surgery Surgery Treatments Vision Correction

Lasers Used in Ophthalmology

Post author By Randall Wong, M.D.
Post date August 19, 2018
3 Comments on Lasers Used in Ophthalmology

Laser eye surgery can mean many more things than laser vision correction. Lasers are used in almost all parts of the eye to treat eye disease such as glaucoma, refractive eye surgery and many diseases of the retina.

The following is a short review discussing the many different lasers and how we use them in ophthalmology.

Laser Vision Correction

Laser vision correction is a very common laser eye surgery. PRK and LASIK are often advertised to reduce a patient’s need and dependance upon glasses (or contact lenses).

Both the femtosecond and excimer lasers are used to perform laser vision correction. The lasers reshape the corneal curvature which heavily influences the refraction of your eye.

Laser vision correction reduces the need for glasses in patients who have nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. Certain corneal scars can also be removed with the laser.

Laser Cataract Surgery

Modern cataract surgery now involve the accuracy and dependability of the femtosecond laser. The laser can be used in crucial parts of the cataract removal process:

creating a corneal incision (the first step)
creating the capsulorhexis (the opening of the lens capsule)
liquefying the cataract
treating astigmatism, if needed

The cataract can be compared to an M & M candy. A candy coating surrounding a chocolate center. In this analogy, the cataract is enclosed by the lens capsule: the cataract is the chocolate center and the lens capsule is the outside candy coating. During cataract surgery, the “capsulorhexis” is the opening created in the front side of the cataract, the candy coating, which allow access to the cataract (chocolate) held within. Once the chocolate is removed, the IOL is placed within the candy coating, lens capsule, keeping the IOL in place.

After Cataract – Posterior Capsular Opacification

During cataract surgery, the intraocular implant is placed inside a clear tissue called the lens capsule. Just like “Saran Wrap,” this tissue is crystal clear. With time, the tissue often becomes cloudy and blurs the vision. This “after cataract” mimics the same symptoms of the original cataract, but vision can be restored with Nd:YAG laser which clears the cloudy lens capsule.

Glaucoma

Several different lasers can be used to treat different types of glaucoma.

Open angle glaucoma, the most common form of glaucoma in the United States, is usually treated with eye drops to lower the eye pressure. When the eye drops fail to work, ALT (Argon Laser Trabeculoplasty), SLT (Selective Laser Trabeculoplasty) or MLT (Minipulse Laser Trabeculoplasty) can be used to treat patients with open angle glaucoma.

These lasers treat the drainage part of the eye, called the trabecular meshwork, to increase the absorption of internal fluid (aqueous humor) and decrease the pressure of the eye.

The laser procedures are similar and differ by the types of laser used: Argon or diode laser, Nd:YAG laser or the minipulse laser.

Laser can also be used to reduce the production of aqueous humor by treating the ciliary body. The ciliary body is located behind the iris and can be treated with argon or diode laser to reduce the production of fluid, thereby reducing eye pressure. This form of treatment is often done in conjunction with cataract surgery.

Narrow angle glaucoma is common in asians and patients with hyperopia. In this scenario, fluid is blocked from migrating through the pupil to the anterior chamber to

Retina and Vitreous

The argon laser, diode laser and minipulse laser are used to treat patients with diabetic retinopathy, swelling from various retinal vascular disorders and others. Tears in the retina are usually treated with the argon or diode laser.

Nd:YAG vitreolysis is performed for certain opacities within the vitreous.

Tags argon, diode, eye laser, nd:yag

Cataract Cataract Surgery

History of Cataract Surgery

Post author By Randall Wong, M.D.
Post date July 2, 2018

This article is part of a series to recognize Cataract Awareness Month.

Cataracts—the clouding of the lens of the eye is a natural part of the aging process and today cataract removal is one of the most common surgeries performed and one of the safest and most effective surgeries, but there was a long history of failure before the modern age of safe and effective cataract surgery.

Couching – The First “Surgery”

The first cataract surgery was described in a textbook written by Sushruta who was an Indian physician who lived on the banks of the Ganges river around 1000 BC. The method he used was called “couching” and consisted of using a needle or a thorn to push the clouded lens downwards into the eye. The stick was used as a tool to displace the clouded white cataract to clear the visual axis. Once the patient claimed that he or she could see clearly the couching stopped. The method had abysmal results with only about a 30% success rate. Today couching is still performed in some remote areas of the third world. The cataract is not actually removed from the eye, but dislodged so that the visual axis is clear.

Completely removing the cataract was first done in 1747 by Jacques Daviel in Paris. Again, the surgery had a high failure rate and many patients died from the procedure. A major difficulty was infection and lack of understanding of “germs.” This was the state of cataract surgery for about 150 years.

Intraocular Cataract Surgery

In the early part of 20th century, cataract surgery patients were given an anesthesia, sometimes cocaine, and the cataract was removed through an incision. Irrigation was used to remove the cataract and the incision was sutured shut. The surgery lasted for hours and patients had to lie flat and keep their heads immobilized for two weeks and once they healed from the surgery they had to wear thick glasses that replaced their removed lenses. There was no such thing as an intraocular lens. As the natural lens had been removed, thicker glasses were required to make up for the focusing power lost by removal of the cataract.

Intraocular Lenses

In 1949 Harold Ridley implanted the first intraocular lens. He was also the inventor of the intraocular lens which made him a pioneer in the emerging biomedical engineering field and paved the way for more developments in implanted medical devices. During WWII, Ridley noted that when shards of acrylic from aircraft cockpit windows became lodged in pilots’ eyes, inflammatory rejection did not occur as did in the case of glass. Making intraocular implans of acrylic were the solution. The eyes don’t react to acrylic and there was now a medium to create intraocular lenses.

Finally, patients were freed from the coke-bottle thick cataract glasses that had never worked well as replacements for their natural lens.

Phacoemulsfication

The technique of phacoemulsification, which emulsifies the clouded cataract lens using ultrasound, was introduced in 1967 by Charles Kelman. His inspiration was his dentist’s ultrasound descaler used to break up and remove deposits on teeth.

The first foldable intraocular lens was used in 1978. A foldable lens can be rolled and will fit inside smaller incisions.

Laser Cataract Surgery

In 2009, laser cataract surgery was introduced. It is a bladeless procedure that uses a computer to create a three-dimensional map of the eye and using that map the computer-aided device precisely removes the cataract and suctions it out. Laser cataract surgery is theoretically allows certain steps of cataract surgery to be done more accurately. Not all ophthalmologists believe laser cataract surgery is worth the cost noting that results are comparable to phacoemulsification.

Today cataract surgery is usually done under a local anesthesia and can correct refractive errors, which means that nearsightedness, farsightedness, and astigmatism can all be corrected with multifocal and accommodating intraocular lenses

Even though modern cataract surgery is extremely safe and effective, make sure you find an ophthalmologist with whom you are comfortable. Get recommendations from friends who have had the procedure or from your family eye doctor. Make sure to find someone who answers all your questions. There are also many intraocular lens options from which to choose.

Tags Cataract Awareness, cataract surgery

Cataract Surgery

Cataract Surgery Can Lengthen Your Life

Post author By Randall Wong, M.D.
Post date January 19, 2017
No Comments on Cataract Surgery Can Lengthen Your Life

As reported by the National Bureau of Economic Research, Americans over the age of 65 are living longer and with fewer disabilities.

Cataract surgery may help you live longer.

These findings are identified in an economic research study which identified certain medical conditions which improved healthy life expectancy. The study found that treatments for heart disease and vision (cataract surgery) improve life expectancy and quality of life.

Cataract Surgery Improves Vision and Life

It’s no surprise that cataract surgery can improve our vision thus allowing us to work longer and drive more safely.

The study cited other examples perhaps not as obvious. Patients who had cataract surgery were compared to those who had cataracts but declined to have surgery. The group who did have cataract surgery had fewer falls leading to a broken hip compared to the comparison group.

As was reported by the American Academy of Ophthalmology, cataract surgery was associated with a 16% decrease in hip fractures. Moreover, those patients who had severe cataracts and had surgery were noted to have a 23% decrease in hip fractures.

Fewer Car Crashes

Other studies have noted similar findings with car crashes. Those who have undergone cataract surgery have fewer car crashes compared to those not having cataract surgery.

In the same AAO report cited above, an Australian research group found that patients having the “first eye” surgery had 13 percent fewer car accidents. The cost savings to the society are not insignificant.

A U.S. study found a 50% reduction in car crashes. This study also found that as this cohort (study group) aged there was a 27% increase in accidents. Those who never had cataract surgery experienced a 75% increase.

What Does This Mean?

The improvements in vision allow us to live safer and lengthen our ability to work. This translates into tremendous cost savings.

There are tremendous cost savings to our society by making us healthier e.g. fewer hip fractures from falls, fewer crashes from improved vision and increasing our productive work years.

The point of the study; however, is to point out that cataracts slowly decrease your vision and most patients are unaware they have compromised sight.

Get your eyes examined regularly.

Tags Cataract, life expectancy