Newsletter January 2025

First Tecnis Puresee IOL at Spire London East – 6/6 N5 Vision & Happy Patient!

Hello and welcome to Retinacare’s first newsletter of 2025.

Firstly I would just like to introduce myself to you. My name is Raj and I am a specialist optometrist who has had the privilege of working alongside Hadi Zambarakji for the past 15 years in private practice. I have also just passed my 10 year anniversary with Kings Primary Care Trust working in medical retina. I am still working as a high street Optometrist at an independent practice and my latest role is as a laser refractive Optometrist in central London. I do like to keep myself busy with a varying role!

As you know Mr Zambarakji has a specialist interest in both vitreoretinal and cataract surgery with many years of experience and often dealing with more complex surgeries. We are both very keen on newer lens designs and in particular delivering a personalised cataract service to suit each patient. In Ophthalmology there is certainly no lack of novel technologies and our goal is to provide patients with excellent vision and minimal side effects.

It is always an honour to look after all of your patients with the same care and dedication.

The focus of this newsletter is ‘The Patient Cataract Journey.’

We understand how daunting it can be when a patient is told they have cataracts and need to have surgery, so hopefully this article can help to alleviate some of their concerns and anxieties.

A referral from you to Mr Zambarakji sets the ball rolling with one of our secretaries, Vickie, Aless or Joy, reaching out to the patient and booking them in for an appointment at their desired location.

Although appointments are booked half hourly, new consultations do take longer and patients can be with us, at their first appointment, for over an hour. They also receive a message reminding them not to drive to their appointment as more than likely, they will be dilated.

It is also incredibly helpful if you let your contact lens wearing patients know that we require them to leave their lenses out before they come in to see us. It means that they can have all of the tests on the day rather than having to come back for them. Soft lens wearers need to be out of lenses for 7 days and, apologies in advance, but wearers of gas permeable lenses need 4 weeks without them.

Patients will always see me first and I will take a detailed history, followed by a comprehensive ocular examination. So any distance vision glasses should be brought along. It is also very helpful for us to have any documentation relating to past eye and general health issues, lists of medications and allergies.

Before any medicated drops are instilled and the corneal surface disrupted, optical biometry will be done and I often apply a generous amount of saline to each eye to get the best measurements. Patients simply have to position their chin on the chin rest of the IOL Master, keep their head forward against the head rest and look into the machine at a red light. The rest is all done by me and the very clever formulae programmed into the machines’ software. The measurements sometimes have to be repeated several times if I am not happy with them. On rare occasions a patient’s eyes may just be too dry for good measurements and they will need to start an intense regime of using lubricants which unfortunately delays surgery. If your patients do suffer from dry eyes you may want to encourage them to use lubricants regularly prior to their appointment.

Eye pressures are normally done by Goldman applanation followed by dilation. We use a combination of Tropicamide 1% and Phenylephrine 2.5%. An OCT is always done.

Patients have a questionnaire and together with the test results help guide Mr Zambarakji to which lens implant would be most suitable for each patient. There is a myriad of lenses out there from simple monofocal to enhanced monofocal, enhanced depth of focus (EDOF) and bifocal – trifocal / multifocal. We also give the patients a cataract leaflet to go over the various lens implant options for them to go through after or in advance of their appointment.

Once dilated, Mr Zambarakji will see the patient for a thorough examination and a lengthy conversation and explanation of his findings and recommendations. It is always a two-way conversation with the patient’s needs and expectations being taken into careful consideration.

The majority of surgeries are performed under local anaesthetic with patients given the option of having an anaesthetist present for light sedation. The patients would also have the option of just having a 5 MG dose of diazepam prior to surgery, as a light alternative to sedation.

Surgery takes place between 5–7 pm and patients are asked to arrive an hour or so before theatre for pre-op preparations. Time in theatre is usually around 20 to 30 minutes depending on each individual case and patients can go home the same evening.

A shield will cover the operated eye, which will need to be kept on at night, when sleeping, for 7 nights. Antibiotic, steroid and non-steroidal anti-inflammatory eye drops will be given prior to discharge for the patient to start using as soon as they are home.

When patients book for surgery, they are sent an information pack, which includes a very handy chart where they can tick off as the drops are applied. It also keeps the patient informed of when drops need to stop or be reduced over the 4 week course of medication.

A follow-up will take place 7 to 10 days post-surgery. Once a patient has completed their course of medication we advise them to see their Optometrist for any update in spectacles they may require. If surgery is needed for the fellow eye, this is usually done 1–2 weeks after surgery to the first eye and both dates would be booked in advance to let the patient make appropriate plans and arrange a suitable date with their Optometrist for a final check and final refraction.

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