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
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
The Crystalline Lens
The Lens
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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
Cataract – Age of Onset
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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
Age Related Cataract –
Causative Factors

Age
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Diabetes
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Environmental: UV-B light, smoking
Advanced Cataract
Cataract – Age of Onset


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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
Subluxed Lens – Marfan’s
Syndrome
Cataract in Juvenile Rheumatoid Arthritis
Uveitic Cataract

Photos of chelation
Cataract in Juvenile Rheumatoid Arthritis
Cataract – Age of Onset


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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
Cataract – Causative
Factors

Medication related: inhaled or oral
steroid intake, phenothiazines
Cataract – Causative
Factors
Systemic disease –
myotonic
dystrophy,
Wilson’s disease,
Atopic dermatitis,
diabetes,
neurofibromatosis
Cataract and Diabetes
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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
Cataract and Diabetes
Cataract and Diabetes
Cataract – Can it be
Prevented or Slowed ?

No definitive proof that intake of
vitamins or nutrients or ‘catalina’
eyedrops decrease incidence of
cataract
Anatomic Types of Cataract
& Their Visual Implications
Anatomic Types of Cataract
& Their Visual Implications
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Nuclear Cataract -

Posterior Subcapsular Cataract
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Cortical
Anatomic Types of
Cataract

Nuclear Cataract -

Posterior Subcapsular Cataract

Cortical
Anatomic Types of Cataract
& Their Visual Implications

Nuclear Cataract -
Change in vision clarity and
eyeglass prescription for distance
Anatomic Types of
Cataract

Nuclear Cataract
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Posterior Subcapsular Cataract
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Cortical
Anatomic Types of Cataract
& Their Visual Implications

Posterior Subcapsular Cataract
Decreased vision especially in
Bright light, glare
Anatomic Types of
Cataract

Nuclear Cataract -

Posterior Subcapsular Cataract
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Cortical
Anatomic Types of Cataract
& Their Visual Implications
Cortical Cataract –
minimally affects clarity
of vision unless advanced.
Common symptom is
glare
Treatment Strategies

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When cataract mild, a change in
eyeglasses helps vision
In patients with more advanced
cataracts or in patients with glare,
surgical treatment is indicated
Cataract Surgery
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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
Cataract Surgery
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Steps – remove cataract and place an
artificial lens in place of it.
Cataract Surgery
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Steps – remove cataract and place an
artificial lens in place of it.
13.0mm
6.0mm
Cataract Surgery Video
Cataract Surgery –
Postop. Period
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Topical steroid eyedrops for 4 weeks
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Topical antibiotic for a week
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Eyeglass check in 4 weeks
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Thereafter, yearly follow-up
Do Cataracts Come Back ?
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NO !
After Cataract (Posterior
Capsule Opacification)
Alternative Locations for Artificial
Lens – Anterior Chamber IOL
Alternate Location for IOL
– Sutured IOL
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Photos
Recent Advances in
Cataract Surgery
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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)
Multiple zones
permit focusing
at distance and
near distances
Recent Advances in
Cataract Surgery
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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)
Cataract Surgery and
Alphablockers

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Alpha blockers cause pupil to behave
unpredictably (does not dilate, floppy iris)
during surgery
Selective blockers (tamulosin, Rapaflo)
have a more profound effect
5 alpha reductase inhibitors (avodart, proscar)
do not affect the pupil
Cataract Surgery and
Alphablockers
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Instruct patients to intimate their eye
doctor if they are having cataract
surgery
Stopping alphablockers prior to
surgery does not prevent IFIS
Dose or duration of use do not have a
significant effect of IFIS
Cataract - Summary
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Cataract is a major cause for treatable
vision deficit
Acute onset of cataract usually not age
related – diabetes, trauma possible
causes
Cataract - Summary
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Cataract Surgery only when patient
bothered by existing vision
Cataract surgery among most
successful surgical procedures but is
not without risk
Cataract - Summary

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Cataract surgery is an outpatient
procedure done using local anesthesia
and involves removal of cataract with
Ultrasound and placement of IOL
For patients desiring freedom from
eyeglasses, options of new IOLs
available
THANK
YOU
FREQUENCY
WHAT IS IT?
•How fast the phaco needle moves back and forth
Frequency
WHAT IS THE FREQUENCY RANGE?
•The frequency of ultrasonic handpieces is
between 27,000 and 60,000 times per second
ASPIRATION FLOW RATE

It is the primary force that attracts material to
the phaco tip
High Flow
Low Flow
• It determines how fast material is drawn to
the phaco tip