High Efficiency Cataract Surgery by Dr. Shawn Cohen, McGill University, Montreal

[DrShawnCohen]

Thank you for your comments. I wish you a quick and speedy recovery and great success! Surgery is only done once but if a "film" or "membrane" develops over the back of the lens that we insert, a painless laser is used to remove it. The film develops in 10-20% of completely routine cases, randomly, and really needs only be cleaned once in a lifetime. "Coke bottle" glasses resulted from not having the lenses we have today!

[rnheacox]

Hi, saw the video, amazing. Having my left eye done as I'm finding it hard to see road signs until right up to them. Surgery is scary though. Question? Has or can it be done more than once? I so wished my mother when she was alive could have had it done again, she had both eyes done at the same tme (mistake) she ended up having to wear "coke bottle " glass's. Of course that was 20 or so years ago. I do hope my surgery is a success. Thanks for the video.

Nanc

[eyemd76]

Hi Shawn,

Great video. Very efficient. I like how you did I/A.  You didn't peel the cortical material from the capsule; it kind of just all came to the tip. What settings do you use?

[DrShawnCohen]

Thanks! The vacuum is linear (usually 550) and that's what allows it to come. When the cortex starts to move or flap around from gentle foot pressure on the vacuum pedal, kinetic energy is imparted to it. Given that bodies in motion tend to stay in motion and bodies at rest stay at rest, flooring the pedal allows the cortex to come before the capsule has a chance to react. Also, with the mouthpiece full, capsule isn't able to approach. Just physics!

[DrShawnCohen]

Aha! Great idea although I now see that what I should have explained in the video was that I am also trying to cut costs and use less equipment. I use a 0.55 cc Provisc for the entire operation for a few dollars and so the cost to the patient for the lens insertion portion is zero. At 30 cases per half day, that gets expensive otherwise.

[bolbystewart]

I liked the video. It was good quality and you are a very efficient and slick surgeon. I have been trying a few extra steps in being more efficient. One is to stop using viscoelastic to inflate the bag for IOL insertion. I started using the irrigating canula from a bimanual I & A set, and shooting the IOL with the acrysert (ALCON) or by using a Staar Collamer. ( Need a plunger system ). Then hydrate the CCI and you are done. I am able to leave out the visco removal step= more efficient

[DrShawnCohen]

It isn't supposed to. Please see my response from 4 months ago in response to the question by Phoneeei. My motto is "pain is forbidden", though the patient can still feel touch, and sometimes pressure. Pain is very rare and when it begins, I stop the operation and give more anesthetic and that solves it. After surgery, it is normal to feel like there is gritty feeling or sand-like sensation in the eye but that usually passes overnight.

[owenwarunek]

does it hurt??

[robsterrex]

do we all have to take this surgery ?????

[DrShawnCohen]

No. Cataract surgery is mainly for those whose vision has dropped and would like to regain it. People with cataracts find the world less bright, may have trouble reading even with glasses, may have trouble with night vision, may suffer from glare in bright lights, and may have trouble driving. Without constraining symptoms, there is no usually need for surgery.

[leetworldfan101]

Whoa My dad just got done with both of his eyes thanks for posting Dr.

[DrShawnCohen]

I wish your dad well. Techniques vary and there is more than one way to do this. In fact, many newer variations have come out since I first posted this video. It's nice to know that there is progress in science and medicine. Best wishes!

[Phoneeei]

One question,is the patient like awake when they are having this surgery done? Because i believe i heard somewere that they leave them awake and just put them medicine to numb them.

[DrShawnCohen]

Yes, the patient is awake and that makes it safer for them. Topical anesthetic drops block any pain. There is even a supplement of anesthetic that can be given at any time if there is discomfort. (no needles) There can be a sensation of pressure at times and the light is annoyingly bright. But I really, really try to reinforce my motto that "pain is forbidden". Modern anesthetics are truly remarkably effective.

[Phoneeei]

@DrShawnCohen I would be scared of doing an eye surgery awake. I had an eye surgery myself when i was about 2 years old...but this surgery is way more different then i went through.

[DrShawnCohen]

I understand. Many people ask for a pill that makes them sleepy and calms the nerves before surgery and it works well. But, at 2 years old, that was likely a 30 minute operation or more under general anesthesia. This is under 10 minutes, at most, and usually even shorter than that. Still, it's surgery and so it's normal to feel scared.

[KonradT4]

I've just had that done to my right eye the day before yesterday. What an amazing result, beautiful, crisp clear vision. Finally I can see in 3D!

The neuroleptic analgesia was incredibly effective. I felt calm, relaxed and serene throughout the procedure. There was no pain or discomfort at all - and no after effects or side effects either. The anaesthetic seemed to be so mild, I felt so completely tranquil but 'normal' at the same time. There was no sense of drowsiness or dopiness. Amazing.

[DrShawnCohen]

@vleon1012 The video was also made for the family and friends of the person undergoing the surgery so that they can also coach the patient through it. It is hard to watch something that will be done to us but we can watch it and reassure or guide our loved ones better. Your Mom is lucky she has you to watch over her interests. I wish her success.

[MouthOfEvil]

Wow, that was very interesting to watch. I'm only a student doing my last year of high school, and we've just finished lookingat how the eye works in biology, but that was extremely interesting and surprising. I 've always thought that you had to remove the lens as a whole, I forgot that they're essentially a thick gelatine-like substance and that you could remove them with suction. This video helped answer some questions I had about eye surgery. Thanks.

[lorenz21100]

i think it hurts......... but NICE ......

[kakarot1234567891234]

@lorenz21100 I work at William Osler, and well even though the patients are fully awake, all we do is IV Sedation, I havent heard any of my patients have any complications, it indeed LOOKS painful, but you see the same patients coming in the following week to get the second eye done and its basically routine since they've had the first eye done and it went well for them

[haggis95]

What if you have Fuchs Corneal Dystrophy - can you have a succesful cataract removal?

[DrShawnCohen]

Yes you can, if the dystrophy is mild and the corneal thickness is still close to normal. That only you and your ophthalmologist would be able to discuss...

[haggis95]

Thanks.

[PrismaticRAYS]

Thank you so much for your encouragement. Yeah, ten minutes isn't too long a torture, I guess. I survived kidney surgery, I suppose I can handle this too. Besides, I'm growing tired of my clouded vision. I just don't want to be that one in 50 that ends up with a serious problem or even blindness. I wouldn't make a good pirate:)

[PrismaticRAYS]

This doesn't look fun at all. I don't want to go through with it. I'm scared like a baby!

[DrShawnCohen]

Eye surgery really can look scary, I agree, because we all cherish our vision. Yet, it isn't painful, although one might think it looks that way. It used to be an hour-long procedure with a long needle to "freeze" the eye. Now it's under 10 minutes with topical drops and gel. Cataract surgery brings back lost vision and remains one of the most successful operations in medicine. One way to feel less anxious is to build a relationship of trust and understanding with your doctor. Best wishes! SLC

[PMNR5]

cool.