Cataracts: A Surgical RevolutionCynthia S. Chiu, MD, FACSDirector, Comprehensive Ophthalmology & OptometryUniversity of California San s.png to l/doc-supp-ophthalmogist2.jpgDemographicsNo financial disclosures Leading cause of blindness worldwide (WHO) 51% of world blindness (20 million people) 3.4 billion each year from Medicare Risk factors: female gender, tobacco,diabetes, UV and other radiation, obesity1

What is a Cataract? “Clouding”of the natural lens Causes blurry vision Difficulty readingDifficulty drivingGlareDouble vision/multiple imagesLoss of color visionDifficulty in the dark site admin/assets/images/lens anatomy.95231805 large.jpgAnatomy of the /0100/005f.gif2

BiochemistryEmbryologyEmbryologyWhat Causes Congenital Cataract? Genetic Tunica Vasculosa LentisInheritanceAutosomal dominantAutosomal recessive Intrauterineinfection Sporadic Riskof 3

Congenital CataractCongenital de24.jpg riley/HomePage/congenital cats/Text Congen cats.html 17 50 022 condary Congenital CataractsWhat Causes Senile Cataract? IncreasingRubellaPersistent Fetal Vasculatureage Family history Diabetes Medications Radiation Trauma Eye s/mv-v15-1407-f5.jpg4

Senile CataractSenile hthalmology/site/Home/Eye Disorders/Posterior subcapsular cataracta/tumakaihi2.jpgMature CataractToxic InsultsPhenothiazinesMature CorticalMature ttp://

Traumatic CataractCataracts Associated withSystemic DiseaseBlunt InjuryElectricShockVossiusRingWilson’s Disease(sunflower aumatic3 1.jpgDiabetes(snowflake cataract)Myotonic Dystrophy(Christmas tree ttp:// fulk/Images/Img0068.JPGPre-Op EvaluationCorneal dystrophiesPre-Op EvaluationPseudoexfoliationRetina and Optic on/imageswv/retina.jpeg6

Primitive Cataract Surgery“Couching”IntracapsularCataract com/7/6103/6283625108 a/Blogs/Ethiopia blog/Patient-before.jpgThe Artificial LensExtracapsular Cataract /images/fader/980/92511 org/media/images/fader/980/21192 22455 harold ommons/f/fd/Plaque for Harold Ridley%27s first intraocular lens at St Thomas%27 Hospital.jpg7

Small, Self-Sealing IncisionThe Phaco MachineHigh-frequency Ultrasound and Vacuum 397 1.jpg imgs/2596 ldable Intraocular Lens (IOL)PhacoemulsificationInject through 2.8mm thalm Mngt 0803 eye-surgery/restor-lens.jpg8

Femtosecond LaserFemtosecond ensxlasers/lensx sdefault.jpgGoals of Cataract Surgery Primary: The Optical System of the EyeRemove cataractClear pathway for visual functionAssist in treatment of other ocular disease Secondary:Provide best optical system forindividual needs of the patient Lens implantCorneal n-20diagram.jpe9

Monofocal Lens ImplantPremium Lens Implants Mono-focal single focal point Distance vision Near vision Mono-vision One eye for distanceOne eye for near Currentstandard of care Covered by most joying-Beach-H-13918268.jpgMultifocal Lens Implant Multi-focal multiple focal points Diffractive light technology allows near anddistance focal pointsMultifocal IOL: Benefits Canachieve distance, intermediate, andnear vision without ads/2013/07/restor1.jpgDavison JA, Simpson MJ. J Cataract Refract Surg. 2006 w Articles/2011/06/27 b.jpg10

Multifocal IOL: Drawbacks Out-of-pocket costRings and halosDecreased image qualityDifficulty with night visionNeed implants in botheyes for mages/ccv-Starburst-or-haloes.pngAccommodative Lens Implant Accommodation /nearfarneutral.jpgCrystalens: Benefits Can achieve distanceand intermediate visionwithout glasses No rings or halos No difficulty with nightvision movement of the lensto improve near visionCrystalens: Drawbacks Out-of-pocket cost Unable to achieve near vision Often need laser capsulotomy Difficult to roducts/Surgical/202x218-crystalens-ao.png11

Toric Lens ImplantAstigmatism Astigmatism Cornea is not spherical Steep axisFlat axisBlurry imagesat all distances eye/eyephotos/pics/Astigmatism-grphc.jpgLimbal Relaxing Incisions Surgicalincisions on the cornea Alternative to toric IOL for low cornealastigmatism Toric lens corrects astigmatismToric monofocalToric Crystalens justable Lens s/LRI.jpgCourtesy of Dan Schwartz, MD, Calhoun Vision Inc.12

ComplicationsEndophthalmitisRetinal DetachmentCorneal DecompensationUCSF Division ofComprehensive OphthalmologyVitreous LossCystoid Macular EdemaChoroidal HemorrhageCynthia S. Chiu, MD, FACSMichele M. Bloomer, MDSaras Ramanathan, 5.353.2802Thank /minions wallpaper cap by nabolsi gfx-d6k0pyo.png13

1 Cynthia S. Chiu, MD, FACS Director, Comprehensive Ophthalmology & Optometry University of