Cataracts and Cataract Surgery

1. Cataracts and Cataract Surgery Surendra Basti, MD LASIK, Cataract & Cornea Surgeon Associate Professor of Ophthalmology Northwestern University Feinberg School of Medicine, Chicago, IL Email: sbasti@northwestern.edu

2. What is a Cataract ? • 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

4. The Crystalline Lens

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

6. Cataract – Age of Onset • 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 children – metabolic, anatomic abnormalities, inherited

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

9. Advanced Cataract

10. Cataract – Age of Onset • Age related (senile) – most common • 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

11. Subluxed Lens – Marfan’s Syndrome

12. Cataract in Juvenile Rheumatoid Arthritis Uveitic Cataract • Photos of chelation

13. Cataract in Juvenile Rheumatoid Arthritis

15. Cataract – Age of Onset • Age related (senile) – most common • 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

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

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

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

21. Cataract and Diabetes

22. Cataract and Diabetes

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

24. Anatomic Types of Cataract & Their Visual Implications

25. Anatomic Types of Cataract & Their Visual Implications • Nuclear Cataract - • Posterior Subcapsular Cataract • Cortical

26. Anatomic Types of Cataract • Nuclear Cataract - • Posterior Subcapsular Cataract • Cortical

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

28. Anatomic Types of Cataract • Nuclear Cataract • Posterior Subcapsular Cataract • Cortical

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

30. Anatomic Types of Cataract • Nuclear Cataract - • Posterior Subcapsular Cataract • Cortical

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

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

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

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

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

38. 13.0mm 6.0mm

40. Cataract Surgery Video

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

42. Do Cataracts Come Back ? • NO !

43. After Cataract (Posterior Capsule Opacification)

44. Alternative Locations for Artificial Lens – Anterior Chamber IOL

45. Alternate Location for IOL – Sutured IOL • Photos

46. Recent Advances in Cataract Surgery • 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 (these lenses are multifocal as opposed to previous lenses which are monofocal)

49. Multiple zones permit focusing at distance and near distances

50. Recent Advances in Cataract Surgery • New IOLs have an out-of-pocket cost similar to LASIK surgery • 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)