Story of a medico wanting to undergo cataract surgery

A sixty-year-old lady family physician, with almost thirty plus years of private clinical practise in an elite suburb of Mumbai. A fitness freak, enjoying an active lifestyle, avid user of computers and mobile phone.

Presented to Kenia Eye Hospital with gradual blurring of vision in both eyes with a history of lasik surgery done about twenty years back for removing glasses dependence. Did not have any physical problems like diabetes or hypertension or any other disease. She was not taking any kind of medications except for calcium supplements and multivitamins.She did not have any other contributing positive history.

On examination she was diagnosed to have both eyes age related cataracts and no other eye problem. The lasik surgery was confirmed on eye examination with lasik flap delineation on the cornea.

Pre cataract work up was done for assessing the measurement and shape of the eye and health of the eye. Namely IOL Master-700, Verion Image guided analysis, Specular Microscopy and OCT - macula was done.

According to the assessment of eye health the various options for cataract surgery with different types of intraocular lens implants were discussed.

Having an active lifestyle, driving at night, not wanting to wear glasses after surgery were her expectations. Being a medico, it made it easier to explain the steps of cataract surgery which was planned under eyedrop anaesthesia and resumption of normal activities within twenty-four hours with not much of aftercare post-surgery. Mainly involving instillation of eyedrops for a month after surgery and avoiding touching of the eyes.

The challenge was to meet her expectations of night driving and no glasses after cataract surgery. These expectations are very normal to expect but in patient undergone lasik surgery the intraocular lens implantation power or number calculation is not that accurate as in normal virgin eyes not undergone any surgery. The present generation of IOL calculation formulas are almost 80% accurate so a chance of 20% cases can have a residual spectacle number post cataract surgery. Now this problem can be tackled by removing the residual error by treating with lasik again that is an augmentation additional procedure may be required was explained to her or other option was to exchange the intraocular lens with corrective lens power.

This challenge was discussed with her and being a medico she understood the limitations and trusted Kenia Eye Hospital and said she is fine with the augmentation procedure if required.

The other challenge was night driving as the present generation of trifocal (multifocal)intraocular lenses with the ability to see for distance, intermediate and near distance have glare and haloes at night making night time driving a problem.

Being a senior family physician she said she has to attend night time visits and emergencies and has to self-drive and this option of a trifocal intraocular lens would create a problem.

So other option discussed was EDOF lens but this had less glare and haloes at night but did have them which could still compromise her night time driving. The last option left was implanting a monofocal lens with mono-vision option with this there would not be night time vision issues but the dependence on glasses for near work would be required. She said reading tiny print on ampoules would be difficult and dependant on glasses.

She was not very convinced with this option either.I explained her the limitations of the lens technology and said let me still research and ponder about any other options.

To my surprise I came across a EFOF (extended depth of focus) lens which was without any rings to cause glare and haloes at night and also was having better ability to see for intermediate and near vision much better than the previous generation EDOF lenses.

I was delighted about this option. The new EDOF lens was named LUCIDIS and was made by Swiss advance vision company from Switzerland. I had a detailed discussion with the company representatives about their product as it was totally new to me and India.

I discussed about this lens with the her with the pro and cons about the lens hearing which she readily agreed as it met her needs of night time reading and decrease dependence on glasses post cataract surgery.

Thus lucidis EDOF lens was planned first for the right eye which had more advance cataract followed by left eye cataract surgery after 48 hrs.

Surgery in the first eye went smoothly and the implantation of the lens in the eye was perfect and post operatively on the first day the doctor was happy to see the distance vision chart and near chart till the last line and was happy with the result and thus consented to do the second eye surgery in matter of 48 hrs which also went uneventful. As the vision was fine no other augmentation procedure was needed. The patient was confident to even join her clinic after the second eye surgery and was under close observation in the post-operative period with periodic weekly visits and at one month after stopping her eyedrop.

Medications she described her vision to be normal and able to regain confidence which she had lost after developing cataract in both eyes. She said the vision is crisp, night time driving is no problem, even the tiny print on injection ampoules is legible and the cataract surgery has met her expectation. As an operating surgeon I was very happy as lot of precision, meticulous planning goes in excepting the surgery with the use of latest technology.

The success of this lucidis EDOF lens implant opened up a new chapter in cataract surgery. This lens has the ability to see for all distances with no glare and haloes and no compromise on night time vision or driving. The ability to see for near is far better than any present generation EDOF lens. Lucidis lens uses a patented technology of PNDB(pseudo non diffractive beam) and instant focus which delivers same high intensity light with good contrast at all distances for far intermediate and near.

After this success story I implanted this lens in many more patients and shortly Presented my experience with lucidis IOL at an international webinar, restoring the visual success gained and positive experience in my patients.

Truly, lucidis EDOF lens has opened up a new elite option for many patients who want an active lifestyle with no compromise.