Guide A Cataract of Breaking Glass (a short story)

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Contents:
  1. It’s the right time for clearer vision
  2. We noticed you’re blocking ads
  3. The Latest Laser Eye Surgery Innovation Shaking Up The Health Industry - And Anyone Can Do It
  4. A Cataract of Breaking Glass by Stephen Livingston

Dr Choyce, along with his more famous mentor, Sir Harold Ridley, were pioneers of intraocular lens IOL for use in cataract extractions in the s. They recognised the shortfalls of conservative management with thick spectacles and unwieldy contact lenses to "replace" the focusing power of the extracted lens after cataract surgeries. That their work - described as chasing windmills then - is today a staple in cataract surgeries, the commonest operation in the world, belies their struggle for acceptance, replete with dealing with disdain and discourteous actions from many colleagues that they had to endure back in those early days.

Inspired by pieces of perspex from shattered warplane canopies that lodged inertly in the eyes of World War II fighter pilots whom he treated as an army doctor, Sir Ridley, who died in at the age of 94, designed the first IOL and implanted the first case at St Thomas' Hospital, London, in It wasn't until significant improvements in designs were made 20 years later, that the IOL became mainstream, and recognitions streamed in for the inventors in the s, culminating in the Gonin medal, the highest award in Ophthalmology and knighthood for Sir Ridley.

The rest, as they say, is history. Some were for lens replacement in traumatised eyes, iris replacement and routine cataract operations. Now seeming "retro", these ideas fathered the current generations of IOLs, and may continue to do so. Fast forward to , generations of IOL designs had come and gone, and millions implanted into human eyes, the vast majority to the recipients' benefit.

IOL materials improved, sometimes arising from mistakes in the past. Together with advances in lens extraction techniques using ultrasound phacoemulsification and nowadays with a touch of femtosecond laser, modern surgical incision sizes are much smaller, and safety and efficacy approaching near-perfection. In fact, IOL surgeries have evolved to become highly refractive, often bettering the pre-operative eye power.

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From my experience as a cataract and refractive surgeon, this contributed to a significant shift in our mindset, even leading to refractive lens exchange without significant cataracts. It seems de rigueur for many resourceful patients to expect no less than perfect eyesight and eye power from their IOL operations, thanks to the sophisticated IOL designs and variety, meticulous pre-operative measurement and surgical planning, which together can and often successfully meet these heightened expectations.

A version of the IOL, called the implantable collamer lens ICL can be implanted into eyes without lens extraction, a solely refractive operation, which I also perform as a premium alternative to laser in-situ keratomileusis surgery or Lasik. New designs continue to pour into the IOL market almost every year. Suffice to say that currently, in general, the simpler IOLs correct basic eye powers, while more advanced IOLs, which cost more, can also manage additional errors such as astigmatism, sphericity and presbyopia such as multifocal and extended range lenses.


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Competition among IOL companies produces some unique differentiating features, whose merits the companies work to substantiate, and ophthalmologists critically assess and responsibly peruse to benefit the visual outcome of their patients' IOL surgery. As a result of the plethora of IOL designs, it behoves any potential cataract surgery candidate to take a moment to understand his or her choices, as the surgery should ideally be done just once in a lifetime.

It’s the right time for clearer vision

Apart from IOL, vision and visual quality results, technique of surgery such as with or without laser should be discussed, as these choices may affect short- or long-term outcome. The final option depends on the activities and lifestyle of the individual, and other aspects of the eye and health. While cost is a factor in the choice of implant and technique, there are alternative strategies that fall not far behind and sometimes arguably better, including glasses or the popular Lasik, for instance, for even further refinement after cataract and IOL operations.

I find that calculating an accurate IOL power for my patients is a rewarding part of my clinic's services. I currently employ a "ray tracing" software based on a Swiss-made eye scanner, and regularly audit the results, which I find excellent, and which I've recently shared at the Asia Pacific Academy of Ophthalmologists congress. As such, with the increased IOL choices, increased "chair time" is expected, and a clear and thorough conversation should be sought between doctor and patient, since these surgeries are rarely emergencies.

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For me, all individuals are unique and so are their eyes, hence a customised approach to the IOL choice is called for. Occasionally, true suitability for some of the more complex IOL designs, such as multifocals bi- or trifocals can only be fully ascertained after a period of post-surgical adaptation, making clear and open communication even more important. As for my two precious textbooks of Intraocular Lens Implants the first and the latest published to date, to my knowledge , I may just read them side by side, for my fascination, perspective and gratitude.

This series is produced on alternate Saturdays in collaboration with Singapore Medical Specialists Centre. Cataract surgery involves removing the cloudy lens from the eye and replacing it with an artificial, intraocular lens implant IOL lens. The procedure, generally performed by an ophthalmologist, uses local anesthesia in an outpatient setting which means you can often go home the same day and causes little to no harm to the patient in fact, most patients are often surprised with how quick the procedure is.

With an overall success rate of 98 percent or higher in restoring vision and a turnaround time of about minutes, cataract surgery is one of the safest, same-day procedures in the world. Source: All About Vision. There are several types of cataract surgery intracapsular, extracapsular, etc. During the procedure, itself, your ophthalmologist will make one or more incisions in the front of your eye. Then, using a phaco probe—which transmits ultrasound waves—he or she will break up emulsify the cataract and remove the remaining fragments before placing the intraocular lens implant IOL lens into the remaining lens capsule.

Source: National Health Service. Not all cataracts are created equally. We have learned over time that certain cataract types are not optimal for manual cataract surgery. Cataracts that are very dense, cataracts that are associated with a weakened cornea and cataracts that are unstable are some of the instances where manual cataract surgery is not ideal. This is where laser cataract surgery shines. Femtosecond laser cataract surgery enables the surgeon to break up a rock-hard cataract before entering the eye, enables the creation of perfect circular openings in unstable and misaligned cataracts and minimizes the creation of by-product energy that can harm surrounding tissue.

In short, it is a much needed and precise tool for these complex cases. A secondary function of the femtosecond laser is astigmatism correction via astigmatic keratotomies.

The Latest Laser Eye Surgery Innovation Shaking Up The Health Industry - And Anyone Can Do It

These are precisely placed incisions in the cornea, the clear, dome-shaped tissue covering the eye. The Ziemer Z8 has been a tremendous tool for our surgeons in tackling the most complex as well as routine cases — all our surgeons have their own philosophy regarding its utility. The role of this technology in your surgical care, therefore, has to be based on a discussion regarding its efficacy and utility for your eye. With 3 million Americans going under the knife each year, cataract surgery is one of the most common and successful surgical procedures performed today.

Source: AllAboutVision. Aside from the more obvious benefits of improved vision e. While cataract surgery is extremely safe, as with any surgical procedure, there are risks though most are rare and can be quickly and easily treated. If, for example, you have another eye condition e. The following are the most common risks you need to be aware of. Other cataract surgery complications include infection endophthalmitis , bleeding and swelling of the retina cystoid macular edema , though these are less common.

As always, if you have any concerns about any of the risks of cataract surgery, ask your ophthalmologist. And as the cataract grows larger, the entire lens may eventually become white. If a cataract is left untreated, it will gradually get worse and affect your eyesight to the point where you may no longer be able to perform daily activities such as driving or reading. Furthermore, it may prevent your doctor from identifying other eye-related problems or operating in the future, should you need it.

While outcomes like blindness are rare, it is possible though legal blindness often comes a long way before total blindness.


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But what you might not be aware of is when you need to have it done. While a doctor can advise you based on your circumstances, the decision MUST always come from you. The procedure may vary depending on your surgery center. At Milan Eye Center, our surgeons and staff prepare patients for cataract lens replacement surgery by providing them with all pertinent information about their procedure.

You and your eye doctor will discuss Traditional vs Bladeless cataract surgery options, as well as the different types of Intraocular Lens IOL implants available during a pre-surgery appointment. Before surgery, patients are given a prescription for eye drops and should use the medicated eye drops exactly as written in the pre-op plan.

While aspirin may continue to be taken prior to surgery, patients who take anticoagulants such as Coumadin or Plavix should talk to their primary care physician or cardiologist to determine whether the anticoagulants should be stopped prior to surgery. Patients should never stop taking anticoagulant medication on their own! And for diabetic patients, no insulin or other diabetic medication should be taken before the cataract surgery.

Heart or blood pressure medication can be taken that morning with a small sip of water. Patients should plan ahead for a family member or friend to drive them home following the procedure. Beginning the night before the cataract procedure patients should not eat or drink anything after midnight, including water. On the morning of cataract surgery, patients should not wear any contact lenses. Patients should shower the evening before surgery. Patients should not apply any makeup including blush, mascara, lipstick, eyeliner, or eye shadow.

Patients should also avoid using any lotion on the face or chest. Patients should dress comfortably with a button or zipper top and leave all jewelry and other valuables at home. Any other questions about medication or before surgery plans, should be asked well before the day before surgery. Milan Eye Center physicians can answer any questions about a specific pre procedure plan. And following the pre-op plan is the first step towards ensuring a cataract surgery procedure is successful and smooth.

A Cataract of Breaking Glass by Stephen Livingston

Once patients arrive at the Milan Eye Center surgery center for their cataract surgery, they must check in at the front desk. Patients will then be directed to a surgical waiting room.

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A nurse will bring the patient back to our Pre-Op area where blood pressure will be taken and an IV will be started. Then an anesthetist will visit with the patient in order to go over the anesthesia plan in depth.