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Retina Care

The practice of Hadi Zambarakji

Newsletter December 2018

Issue 6.2

Modern Cataract Surgery

Mr Hadi Zambarakji, Consultant Vitreoretinal and Cataract surgeon at the Spire London East Hospital and The Holly Private Hospital looks at the patient’s journey and decision-making process involved in today’s modern cataract surgery.

 

Tips

Myopic patients do not like to lose their excellent near vision, especially if not yet presbyopic. Hyperopic patients, on the other hand, do not see well at any distance so tend to be pleased if the post-operative unaided visual acuity is improved for distance. Astigmatic patients will not have good unaided visual acuity after surgery if the astigmatism is not corrected so sometimes a toric lens implant may work best (look out for the next newsletter about issues relating to toric lens implants!).

Lifestyles are important to discuss with the patient. We need to know about the patient’s hobbies, activities and sports interest. Do they fish and play golf, do they play any music instruments or are they an outdoor/indoor person. How much time in a day does the patient spend on the computer or are they the unofficial taxi driver driving children around all day from appointment to appointment. It is also really important to find out about night driving especially if a patient is a professional driver.

Patient expectations hold the key to planning a successful treatment and always discuss what the patient wants to get out of the surgery. Talk to them at length and listen to what they are saying not what you think they are saying. Surgery will often be a compromise and if you think the patient does not fully appreciate the compromises or that you cannot deliver what is required, there is no harm in deferring surgery.

 

Options for Surgery

Sometimes the patient is happy to wear reading spectacles after surgery and just wants correcting for distance. If this is the case, a monofocal lens implant would be most suitable.

Monofocal lens implants are also used to correct for distance in one eye and near in the non-dominant eye (this is called monovision), which gives good spectacle independence in many patients, but poor stereo-vision. For patients suitable for monovision correction, the Optometrist would ideally do a contact lens trial prior to referral, which gives invaluable information about the proposed treatment plan and type of lens implant to be used.

Multifocal lens implants are a great option but have certain compromises. Some patients suffer night vision difficulties like halos or glare. Night-time dysphotopsias are another possible complication of multifocal lens implants that give the patient unwanted images such as flashes, starbursts and halos. Intermediate vision tends to be limited with multifocal lens implants, despite good distance and near vision therefore computer vision may be compromised.

Patients who drive much at night are usually not good candidates for multifocal lens implants be-cause of the above night-time issues resulting form the pupil dilating in the dark.

A newer type of lens called the extended depth of focus (EDOF) lens implants will give good dis-tance and intermediate vision but with poor near vision. With the EDOF lens implants, I would tend to aim for a low myopic outcome in the second, non-dominant eye to achieve slightly better near vision. The trade off here is that the distance vision will be compromised in the non-dominant eye. The night vision complications of EDOFs are much the same as for multifocal implants.

Trifocal lens implants are also popular giving a good range of vision, but are not so forgiving if the patient has a degree of residual astigmatism and night vision issues will be the same as multifocal implants.

 

Referral Tips – Please include

  • Refraction – Hyperopia / Myopia / Astigmatism
  • Cornea – K readings
  • Degree and type of cataract
  • Hobbies
  • Occupation
  • Need for driving at night
  • Glaucoma
  • Risk Factors:
    • Glaucoma / retina
    • Tamsulosin / Doxazosin or other alpha blockers

 

 


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Useful links

The Royal College of Ophthalmologists:

This should probably the first site accessed by anyone in the UK who would like to obtain information about eye care. The College provides valuable support for professionals and patients.

www.rcophth.ac.uk

 

The National Institute for Health and Care Excellence (NICE):

NICE Supports healthcare professionals and others to make sure that the care they provide is of the best possible quality. NICE provide independent, authoritative and evidence-based guidance on the most effective ways to prevent, diagnose and treat disease and ill health, reducing inequalities and variation.

www.nice.org.uk

 

BEAVRS:

BEAVRS is the acronym for the British and Eire Association of Vitreoretinal Surgeons. The aim of the Association is to promote high quality patient care by supporting and representing British and Irish Vitreo-Retinal Surgeons through education, research, audit and revalidation.

www.beavrs.org

Euretina:

This should probably the first site accessed by anyone in the UK who would like to obtain information about eye care. The College provides valuable support for professionals and patients.

www.euretina.org

 

The Macular Society:

This society has been supporting people with macular conditions, including age-related macular degeneration (AMD), for 25 years. The society offers information and support while funding research to find a cure. All services are free so that no one has to face a macular condition alone. This is the best site in the UK if you are a patient with macular degeneration and would like to know more and seek where can you get support.

www.macularsociety.org

 

Royal National Institute of Blind People (RNIB):

The RNIB is the leading charity offering information, support and advice to almost two million people with sight loss. The RNIB provide practical ways to help patients live with sight loss, and give advice to help travel, shop and manage money and finances independently. The RNIB also give advice on technology for blind and partially sighted people.

www.rnib.org.uk

The British Medical Association (BMA):

The BMA stand up for doctors both individually and collectively on a wide variety of employment issues and, since the inception of the NHS, have been formally recognised for collective bargaining purposes within national negotiating machinery and by individual employers at local level.

bma.org.uk/about-the-bma

 

The “access to work program”:

This government program helps pay for practical support so anyone with a disability can do their job (in the case of my patient, this is usually a visual disability). This is free of charge to anyone in the UK.

www.gov.uk/access-to-work/overview

 

The implantable intraocular telescope for patients with advanced age-related macular degeneration:

The CentraSight treatment programme uses a tiny telescope, which is implanted inside the eye to improve vision and quality of life for individuals affected by end-stage age-related macular degeneration. The above link allows the patient to find the necessary information about this program. Mr. Hadi Zambarakji is currently in the process of developing a patient pathway and will be offering with CentraSight this new technology to his patients.

en.centrasight.com/treatment_process

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