Saturday, December 31, 2011

Cataracts

On Wednesday I watched 4 more cataract surgeries (three of which were for Unite For Sight), so I thought I might try to explain what happens. Prior to my UFS training this semester, I didn't know that much about cataracts, other than Claude Monet had them and sometimes I saw old cats with them.
Cataracts can occur congenitally as well as, more often, in adults. What happens is that the lens, which is supposed to be clear, becomes clouded. Initially, cataracts are kind of yellowish, so it's kind of like permanently seeing through sunglasses. But as a cataract progresses, it gets both darker and thicker, and eventually blocks all vision. However, there are a few available surgeries for cataracts, and it is one of the more simple solutions for blindness.

Since eyes freak some people out, I'm using only illustrations I found on google images. If you really want to google pictures of cataracts and cataract surgery, go ahead.

The surgery that most doctors in developing countries use is slightly different than the one used in the US, but it is just as effective but tends to work better with the kinds of materials that are available and more affordable.

So in the lamest of layman's terms, here is what happens:

First, a local anesthetic is administered under the eye. Dr. Flores said that if the anesthesiologist is there sometimes they do full anesthesia, but normally the patient is completely awake for the procedure and gets up and walks away a couple minutes after it's done.

Then an initial cut is made in the outer layer of the eye, and another two cuts are made on the outside of the iris, making sort of a trapezoid.
This gel-fluid stuff is pumped into the eye to keep the pressure stable, as well as put on top of the cornea to protect it while all the tiny knives are in use. Using the 2nd and 3rd cuts as entry points, a tool is inserted into the eye, and it begins to loosen the cataract. Eventually a scoop tool just scoops it out, which one time made me faint but mostly it's really cool to see and kind of satisfying to watch. There it goes!

A new lens is inserted, which has two springy tendrils that help keep it in place. After being centered, the surgery is basically done.

For most surgeries, stitches are not needed. This cuts down on the amount of times follow-up appointments are needed, which is especially good for patients who come from far away, and allows surgeons to see more people.

Dr. Flores added a second microscope for his last two surgeries so I could see the same things he was seeing which was so cool. In related news, I am becoming somewhat concerned about how interesting I think watching eye surgery through a microscope is.

Another ophthamologist, Dr. Mathos, was doing a surgery for glaucoma immediately after, so she let me watch that as well. Glaucoma is particularly difficult, because it's an issue of pressure. Without proper drainage, the eye builds pressure which presses on the optic nerve and damages vision gradually. This is irreversible, but caught early, eye drops and/or surgeries can be used to regulate pressure and prevent vision loss. Dr. Mathos worked with a patient who had already gotten surgery to drain the aqueous humor to treat his glaucoma, however, because he was young (he looked like he was in his 30s), the cuts had healed and the aqueous humor wasn't draining anymore so he needed it again.

Anyway... the OR is really cool!

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