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cataract surgery

New procedure improves access to eye care
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By Susie Strachan
Nov/Dec 2017

As she awaits her turn for cataract surgery, Lorraine Beck starts to explain how her poor vision has affected her daily life.

"I've had horrible vision since birth," she says. "For the last two years, my ability to focus on things went away. I was finding it hard to drive, hard to see things after dusk."

Beck's story is not uncommon. Thousands of patients come to the Misericordia Health Centre (MHC) every year for cataract surgery.

But this one will be different. Unlike regular cataract surgeries, this one will be performed without sedating the patient.

Dr. Stephen Brodovsky
Dr. Stephen Brodovsky performs the no-sedation
cataract eye surgery on a patient at the
Misericordia Health Centre.

The "no-sedation" procedure has been performed at Misericordia since August as part of a pilot project. The main benefit of the new technique is that it saves time and money that can be reinvested into doing more cataract surgeries, says Dr. Mathen Mathen, Head of Ophthalmology for the Winnipeg Regional Health Authority.

"No-sedation is a new alternative to patients with no other medical issues," says Mathen, adding the biggest change is that an anesthetist is not required to sedate the patient. "There is no IV, patients can walk into the operating room, and, ultimately, it means a faster recovery time."

By performing 1,500 no-sedation cataract surgery cases this year, MHC ophthalmology surgeons will add 200 additional cataract surgeries with the savings. Surgeons in Brandon are also using the no-sedation process for cataract patients.

Cataracts without sedation are an extension of the innovative work the MHC team has been doing for years.

In 2015, for example, a research study pre-screened cataract patients into two categories: high risk and low risk. The low-risk patients no longer require a pre-operative history and physical with their family physician, saving patients' time and $1.2 million annually in unnecessary testing and extra doctors' visits.

No-sedation patients are the lowest surgical risk in the low-risk group, says Mathen.

For her part, Beck was happy to be part of the pilot project, one of about 10 patients who underwent no-sedation cataract surgery on this day.

Today's procedure involved her left eye; she had undergone cataract surgery for the right eye earlier in the month.

"The first surgery (performed by Dr. Stephen Brodovsky) went so well," she says. "My vision was so improved that my right eye was almost perfect. I could see things clearly at a distance," she says.

For today's procedure, Beck was prepped with eye drops, which dilated her left eye. The nurses walked her into the operating room, helped her onto the bed, and draped her face and body. Brodovsky then administered the freezing drops to numb Beck's eye.

Then Brodovsky went to work, using a microscope to maneuver small tools to make a tiny incision in the side of Beck's eye. An ultrasound tool was used to break up the cataract, which was then vacuumed out. Finally, he inserted an intraocular lens, unfolded it and got it into place, before closing up the incision. The lens will allow Beck to see at almost 20-20 vision, although she will still need glasses for reading.

Once the operation was done, the nurses helped Beck sit up. She was then able to walk out under her own steam to the recovery area. The whole procedure took just under 10 minutes, shaving at least five minutes off the time it would take to do a surgery with sedation.

While waiting in the recovery area for her ride home, Beck says she can already see with the new lens in her eye, even with the clear eye shield placed on her face.

"It's going to get better very quickly, once the dilation goes down. It's already a tremendous improvement," she says. "I can't say how comforting it is to have Dr. Brodovsky and his team talk you through the procedure and tell you what they were doing. It was great."

Susie Strachan is a communications specialist with the Winnipeg Regional Health Authority.

What you need to know about cataracts

What is a cataract?
A cataract is a clouding of the lens, which is caused by the aging process, blunt trauma or some systemic diseases. Some people experience blurry vision, haziness, double vision, difficulty with night driving, and sensitivity to light. In a normal eye, light passes through the clear lens and is focused on the back of the eye. In an eye with a cataract, the lens becomes cloudy or foggy and vision becomes distorted. When your day-to-day activity is affected by decreasing vision, it may be time to have cataract surgery. The only way to treat a cataract is by removing the lens.

How is it treated?
When the cataract interferes with normal daily activities, you can be referred to an ophthalmologist to have it removed surgically. During surgery, ultrasonic waves break down the lens material and the surgeon removes it through a very small opening. An intraocular lens (IOL) is then implanted to replace the natural lens. There are two types of lenses on the market, and your surgeon will discuss with you which type would best suit your eye condition and your lifestyle.

What is an intraocular lens?
An intraocular lens is an artificial lens for the eye, also called an IOL, which replaces the eye's natural lens during cataract surgery.

What type of IOL is right for me?
IOLs come in many different strengths, just like prescription eyeglasses or contact lenses. Your doctor will determine which lens is best for your eye.

What is an IOL made of?
Commonly, IOLs are made of acrylic or silicone material.

Are there any complications after having an IOL implanted?
The success rate is excellent. Complications are rare and most can be treated. Retinal detachment, infection, inflammation, or elevated intraocular pressure may occur.

Is it ever necessary to replace an IOL?
Your eye will normally tolerate an IOL very well. Only rarely would an IOL have to be replaced. For more information about cataracts, please visit the Eye Care Centre of Excellence website.

Source: Eye Care Centre of Excellence