Cataract Surgery 2024! Laser & Femto, Multifocal & Light Adjustable Explained!

hey everyone welcome back my name is Dr Jeffrey Trent and today we're going to talk about everything you need to know about cataracts and cataract surgery so let's begin before we talk about cataracts and cataract surgery let's go over the eye anatomy and I love analogy so this will help make things very simple to understand in the front of the eye you have the cornea it's very similar to the front glass lens in a camera lens inside the eye you have your human crystallin lens that's what becomes a cataract it is similar to the deepest innermost Glass lens in this lens right here and of course you also have the retina that's your eyes sensor very similar to how a camera has a sensor right here and lastly you have the optic nerve the optic nerve connects the eyeball to the brain similar to how a USB cable connects the camera to a computer now that we talked about basic anatomy let's talk about cataracts cataracts occur because that that inner lens inside your eye turns slightly yellow and opaque with time cataracts are a common eye condition that affects millions of people especially when they get older due to the yellowing and the clouding of that lens your vision becomes more blurred and in fact a lot of people described a slight yellow filter in their vision and most if not all patients always tell me that when they're driving at night they see a lot of halos around headlights and a common question I always get as an opthalmologist when should I get cataract surgery well the answer is it depends as an eye surgeon I get a couple measurements to help find that answer with glasses if you're having difficulty reading that 2040 line you should probably consider cataract surgery and that's because many states have a minimum requirement to be able to legally drive in addition to that simple objective measurement what's more important is what you're experiencing it's not what I see that matters it's what you you can't see so if you can't work if you can't drive or you can't do the hobbies that matter to you you should probably consider cataract surgery now let's talk about what happens during the cataract surgery evaluation of course we want to see what your current vision is so we will measure you for glasses just to see what your best corrected vision is in a pair of glasses we will also get a couple other tests just to see if the blur vision is due to the cataracts or some other cause like glaucoma or macular degeneration so the test I like doing is called an O test the ooc is a great way to look at the optic nerve and the retina remember it's so we can look at that USB cable and that camera sensor and of course we'll get other tests called topography to look at that front glass lens and biometry to look at that lens inside the eye how is cataract surgery performed cataract surgery is performed as an outpatient procedure meaning you go home that same day we try to make make you as comfortable as possible so we do put numbing eye drops inside the eye and of course we have an anesthesiologist to keep you calm and relax during the entire surgery after ensuring that you're calm and relaxed we then place an eyelid holder into the eye so I can get to the Cataract then I make small incisions into the eye I use an instrument to break up the Cataract into small pieces and I remove the Cataract next we replace the Cataract with an intraocular lens implant called an I to help restore your vision simple right well there's a little bit more to that but let's talk about now the risk and benefits for cataract surgery with cataract surgery you can expect to see better not only do patients describe seeing things in more sharp and finer detail a lot of people do say that colors pop again and often times with cataract surgery if you wore thick glasses before cataract surgery usually we can choose a lens implant that can help really minimize miniz your need of glasses of course there are risks with cataract surgery let's go over some of the more common issues and then move along talk about the very severe complications that can occur with cataract surgery dry eyes dry eyes is very common after cataract surgery patients with dry eyes experience what's called a foreign body sensation meaning they feel like there's dirt or sand in their eyes their eyes might be red or even slightly blurred we usually take care of dry eyes with artificial tears but some patients do require stronger medications for a very detailed overview about dry eyes and how we take care of it click this video right here droopy eyelids remember the eyelid holder that we talked about well that eyelid holder can stretch the skin of the eyelid so your eyelids May droop just a little bit to address this we can do an eyelid surgery to help lift the eyelid up glare sometimes after cat surgery patients can report glare so when they look at headlights or lights at night they'll notice a little bit of streaking or a little bit of rings around these lights these are more common with certain types of lenses such as the multifocal lens posterior capsular pacification a posterior capsular pacification is when the capsule holding the lens implant becomes hazy with time during cataract surgery we remove the inner part of the Cataract but leave the outer capsule that outer capsule is important because it holds the new inocular lens implant however that capsule can become hazy with time patients with a posterior capsule pacification report a little bit of blurred vision and a lot of glare the good news is we can address the hazey capsule by doing an in-office procedure called a yag laser capsulotomy that creates a round opening into the hay capsule to restore your vision again a posterior capsule pacification is common it can occur in about 25% of patients who get cataract surgery recurrent inflammation during the healing process of cataract surgery we prescribe a variety of eye drops one of them is a steroid that steroid eye drop is supposed to address the inflammation and most of the time I have my patients on these drops for about 1 month sometimes patients with recurrent inflammation experience red eyes eye pain light sensitivity and when I examine their eyes there's still a little bit of inflammation so in that case instead of just using the eye drops for 4 weeks we sometimes need it for about a total of 2 months that can usually address the recurrent inflammation retain lens fragment during cataract surgery remember I said we broke up the Cataract into small pieces and we remove the entire cataract however small pieces of the Cataract May remain in the eye of course it's not intentional but if there are what's called retained lens fragments we can use medications to help that part dissolve but sometimes you do have to go back into surgery to remove that teeny tiny piece out again patients with retained lens fragment can get a little bit of light sensitivity because they have a little bit inflammation and sometimes they may have slightly blurred vision as well floaters and retinal detachment floaters are very common in general but often times patients May notice floaters a little bit more after catx surgery usually it's not a big deal and the Brain usually adapts to it however in very rare cases patients can get what's called a retinal detachment that's an eye emergency so if you have flashes floaters or if you're having what's called a black curtain sensation where you can't see very well in the periphery call your eye doctor immediately this is an eye emergency ulitis the most serious complication of any eye surgery is ulitis ulitis is when you get an infection inside the eye patients with doit have very blurred vision significant eye pain and their eyes tend to be very red as an eye doctor we try to minimize the chance of ulitis by practicing sterile surgical technique however in rare cases this can still occur the management of UL theit includes a combination of eye drops injections of medications and sometimes even surgery now that we've talked about cataract surgery let's move to the fun part which is talking about the lens implants available for you but before we get to that point let's go over a couple critical visual concepts the first is accommodation when you were young you had the ability to look at something far away and up close but you might have noticed that not everything was in focus at the same time let me show you what that's like look at the cell phone right here when you're looking at the cell phone the background is blurry but your phone is sharp but when you change your gaze to look at the background you you will notice that your phone is blurry the reason why that's occurring because inside your eye you have eye muscles that can change the shape of that lens when you're young that lens is very flexible the process of changing the lens shape and size is called accommodation when your eye muscles are relaxed your lens takes its more natural oval shape this allows you see things far away pretty clearly however when your eye muscles contract the lens takes a very round shape this increases the power of that lens and allows you see things that are up close this brings up the next important visual concept visual zones we as opthamologists like dividing visual zones into three distinct areas number one is distance distance vision is for things that are far away you use your distance Vision when you're doing things like watching TV driving looking at road signs the next zone is the intermediate Zone that's like for Something 2 to 4 feet away basically at an arms length that's for things like using your computer or when you're driving looking at your speedometer the third visual zone is the near Vision that's for things that are up close so when you're reading a book reading your prescription bottles or again that phone you're using your near Vision as opthalmologists we often talk about targeting these visual zones so targeting either distance intermediate or near what we mean by that is we're picking a lens that will allow you to see best in that visual Zone does that mean you'll be able to see in that visual Zone without glasses well the answer is it depends there are other factors that affect whether or not you need glasses and one of them is a stigmatism and so that brings us up to the third visual concept astigmatism astigmatism means that your eyeball isn't round like a soccer ball but more shaped like a football there are two factors contributing to astigmatism the corneal astigmatism which is the front glass lens and the L particular astigmatism which is the inner Glass lens for the purposes of cataract surgery all I want you to remember for astigmatism is that on one side it's steeper than the other side and that can affect how the light is bent towards your eye now that we've gone over those three fundamental visual concepts let's now move into the lenses there are several types of lenses out there the first is the standard monofocal lens the monofocal lens is great at getting one visual Zone into Focus that's why it's called a monofocal that means you'll need glasses to see the other visual zones most of my patients prefer to see far away as clear as possible so they'll ask me to choose a lens to Target the distance visual zone so that means for things like reading a book using your computer you'll need glasses to see those areas well and sometimes patients ask me to do the opposite where they ask me to Target the near visual Zone and in that case you'll wear glasses to do things like drive or read road signs there are Pros for this monofocal lens the first it's the most cost effective lens and the second it has the least amount of glare compared to the other types of lenses however there are some Cons with this lens if you're trying to be Glasses free this is not the option for you you will need glasses to see the other visual zones now let's talk about multifocal and extended depth of focus lenses there are two popular types of lenses that allow you see in multiple visual zones at once the first is the multifocal lens the multifocal lenses produces multiple focal points that means it allows you see multiple visual zones with many of these multifocal lenses you can see both at distance intermediate and near pros this lens implant can really reduce your needed glasses for that reason the satisfaction rate is about 95 to 99% but it's not perfect perfect there are some cons some people may notice glares and Halos with this type of lens implant and there still might be a decreased contrast sensitivity and lastly not everyone is a suitable candidate for this lens implant if you have bad diabetic retinopathy macular generation or glaucoma I typically do not recommend this lens implant for you the other type of lens implant that's great for multiple visual zones is called the extended dep of focus lens this is a NE type of lens implant that gives you an elongated focus of vision unlike a multifocal lens implant which creates multiple focal points an edoff lens creates one single continuous focal point the pros of this type of lens is it can reduce your need of glasses to see multiple visual zones as a rough rule thumb the edoff lenses are really good at distance and in intermediate and this lens implant may be an option for patients with early to mild macular generation and glaucoma I conditions that would not have been suitable for the multifocal lens implant the cons of this lens is that it doesn't give you as good near Vision as a multifocal lens implant with certain types of edoff lenses you can get a reduced contrast sensitivity now let's talk about toic lenses toric lenses address a stigmatism remember if you have a stigmatism one axis of the eye bends light more than the other axis and as we mentioned earlier there are two parts contributing to stigmatism the corneal stigmatism which is the front of the eye and the lenticular astigmatism and during cataract surgery since we remove your ey's natural lens mathematically the only part contributing to a stigmatism left after catc surgery is really all coming from the cornea and so during cat surgery there's two ways we can address a stigmatism number one we can make incisions into the cornea to reduce some of the astigmatism the larger the amount of astigmatism the larger the incision we need to make in the cornea the second is we can insert a special type of lens called that toric lens to replace your eyes natural lens the larger the amount of a stigmatism the larger the power of that torque lens will be all the previous lenses that we talked about the monofocal the multifocal the extended depth of focus lens all have a toric option so that means you can get a monofocal toric lens a multifocal toric lens and an extended depth of focus toric lens to decide whether or between I like doing number one making an incision to the cornea or option number two doing a toric lens I usually look at the amount of astigmatism that a patient has if it's small amounts I prefer making the corneal incision but for larger amounts of astigmatism I do prefer the toric lens implant the reason being for corneal incisions the bigger the astigmatism the bigger the incision so for really large amounts of astigmatism I have to make such big cuts that I really don't recommend it now let's talk about light adjustable lenses there's a new type of lens implant that allows you to adjust the power of the lens after cataract surgery and we do so by using an in-office laser performed after cataract surgery the cool part is you can also address small amounts of a stigmatism as well often times eye surgeons will do multiple adjustments to fine-tune and see what visual zone or what power patients perform most before locking it in the pros of this lens type is that you can adjust the power the lens a few times before locking things in that gives you a really good trial period the C of this lens implant though is that due to the cost of the equipment used to just the power of the lens implant it may be the most expensive in addition it does require the most visits to the doctor's office because you have to do that to adjust the power now let's talk about ftoc laser with routine cataract surgery we're using instruments to do every step including making the round opening into the lens implant using the entire instrument to break up the Cataract into small pieces and of course for patients that are trying to correct a stigmatism we use instruments to make our corneal incisions with fto cataract surgery a computer is helping us do some of these critical steps that means the opening lens is centered so when we do the multifocal lens or the torque lens I hit the Sweet Spot of that lens a little bit easier in addition by softening the lens it helps make the step to remove the Cataract a little bit easier during cataract surgery and most importantly with that laser we can create precise incisions into the cornea to address address small amounts of astigmatism now for the critical postop period I always have a few restrictions and rules for my patients number one wear that ey Shield the Eye shield that we give you at the surgery center please wear that at night for the first week after catar surgery you might accidentally rub your eyes and that ey sh will help prevent you from doing that number two avoid eye rubbing eye rubbing can cause a lot of damage to your eye number three avoid getting water into your ey that means when you bathe make every effort to prevent soapy water from hitting your eyes number four minimize physical activity as a rough rule of thumb I tell patients no more than 10 to 15 lbs if you have to hold your breath to lift something it's probably too heavy also don't bend at the waist keep your head above your heart at all times and of course the most critical thing is to follow the postop eye drop instructions during each visit we're checking to make sure the eye is healing properly so we might be adjusting the steroid the non-steroidal eye drops or even the antibiotic so follow the instructions to the T now for a few commonly asked questions number one can I use my eyesight right away after cataract surgery the answer is of course you can read as much as you want you can watch as much Netflix or television there is no limitation to that however you might notice that for the first few days your vision's blurred and that's to be expected number two when when can I expect to see again well the ansers depends most patients have routine cataract surgery can expect the first few days to be blurred there are some patients to see 2020 right away that's the exception not the rule and I also get asked can I go back to work right away and the answer to that is also it depends it depends on your type of work if you do a lot of desk work of course you can return within a few days but if you do a little bit of heavy lifting remember that 10 to 15 lbs you need to be be off heavy weights for about 2 to 3 weeks and the one last thing I want to leave you guys with is when to call us right away remember blur vision eye pain and irritation is common after cataract surgery however if you're having flashes or floaters severe headaches with nausea and Ving call us right away because you could be having signs of a rone attachment or even high eye pressures the only way to know is to be examined by your eye surgeon anyways I hope you found that overview of cataracts and cataract surgery to be very helpful don't forget as always your eyes tell thanks for watching we'll see you next [Music] time

Channel: Jeffrey Tran, MD

Views: 31,182

Keywords: Ophthalmology, Medical Education, Optometry, Eye Problem, Education, Medicine, Surgery

Id: OhzKFQoSF3I

Length: 20min 43sec (1243 seconds)

Published: Sun Jan 07 2024