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Cataract surgery 2016

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thomas poole

on 24 April 2018

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Transcript of Cataract surgery 2016

Cataract surgery: past, present and future
Journey to the summit
GOAL:
excellent vision at all distances without glasses



The future
Improved refractive outcomes
Short and long sight: accurate biometry

Laser interferometry
Femtosecond laser
Management of astigmatism
Multifocality?
can the NHS afford these special toric & multifocal lenses ?
Toric lenses

It was a trip to the dentist that led to what was arguably the most important development in cataract surgery of the 20th century. By the mid-1960s, Charles Kelman, who had already developed a frozen probe for removing cataracts, had tried some 40 prototypes in his quest to dissolve the lens during cataract surgery. He had first thought of developing “some gear-screw mounted, meat grinding type of device”, but everything he tried would crush the lens. He was having no success, and was getting close to spending the last of a US$299 000 grant the Hartford Foundation had given him for the project.

He was despondent, and looked a mess, having worked long hours, late at night, for a year to prevent anyone knowing what he was up to. “I thought I might face defeat better if I looked better, and so I prepared”, Kelman wrote. “The haircut came first, then a shoeshine, and finally, the dentist.”

But when he went to his dentist, Larry Kuhn, an early adopter of the ultrasonic probe to remove tartar, he “felt an exquisite vibration and heard a high-pitched sound”. He jumped out of his chair, asked what device Kuhn was using, hugged Kuhn and his assistant, and ran back to his lab to pick up a cataract that had just been removed. Returning to the dentist’s office, he picked up the probe and used it to make grooves in the cataract. “I knew that it wouldn’t be quite that easy, that the instrument would have to be modified perhaps a hundred times, but I also knew that I had found, finally, in the eleventh hour, the road that would lead to a small incision cataract surgery”, Kelman wrote.

Multifocal lenses
PCO
At Frimley Park:
2600 operations per year
cases filtered by GPs and optoms
<6/9 or problems driving
6/18 "any eye"
clinical decision

(cataract doesn't mean you need cataract surgery: your opinion is extremely important)
Phacoemulsificaton (small incision)
what % get it?
who needs laser?
middle ages
1746
Queen Victoria
BASE CAMP

History
innovative lens designs
True corneal power
New biometry methods - radial basis function
Better prediction of lens position
All will give better biometry
Next generation of intraocular lenses
??Injectible flexible polymer lens to give true accommodation
Affordable for all
microscopes, instruments, sutures
1967
UK
intraocular lenses 1980s
small incision 1990s
less wound-related astigmatism
"ripe"
millisecond: thousandth
microsecond: millionth
nanosecond: billionth
picosecond: trillionth
femtosecond: quadrillionth
femtosecond??
our laser uses infrared pulses of 200 femtoseconds duration
what does it do?
Full transcript