What are Cataracts?
Cataracts can be described as the clouding of the clear lens of the eyes. Thus the individual who has cataracts will experience cloudy vision, a thing that makes it difficult to read or drive. Cataracts develop slowly over time and will not disturb an individual’s picture, but with continued growth, they will interfere with the person’s vision. In scientific terms, it can be referred to as the opacification of the crystalline lens, resulting in visual impairment.
What Causes Cataracts Formation
Aging is the most common cause of cataract development; exposure to ultraviolet radiation can also lead to the formation of cataracts and the consistent use of tobacco products. However, age is the most important factor that encourages the development of cataracts.
According to the Visual Impairment Project in Australia, it was discovered that the prevalence of cataracts increases after individuals turn 40. And by the time they reach 70, a good number will have developed cataracts, and when they reach the age of 90, all of them will be infected.
Which Was The Earliest Method Used To Treat Cataracts
Back in the day, cataracts were treated via a process called cataracts couching; the process was performed on mature cataracts. What you must, however, know is that the cataract was not removed from the eyes instead, it was dislodged out of the visual axis using a needle. Therefore, cataracts remained in the eyes, but they no longer blocked light and improved vision.
Reasons for Developments in the Methods of Treating Cataracts
As much as couching was considered a success, it still retained a cataractous lens, and the fact that it lacked an aseptic technique, the effect was harmful to the eyes. And which resulted in blindness for a short period after the procedure.
Couching is believed to have been used up until the 18th century, and as early as 800 BC, an Indian surgeon is believed to have been the first person to perform extracapsular cataract extraction. The procedure was branded extracapsular simply because the lens was not removed. The year 1747 marked the day when the first cataract extraction was done by a French surgeon.
His procedure turned out to be far more effective than couching. The procedure involved making a sizeable corneal incision measuring more than 10mm. The lens capsule was punctured, expressing the nucleus; he extracted the lens cortex through curettage. The extracapsular process showed significant progress compared to couching, but it wasn’t free of postoperative complications, including retained lens remnants, poor wound healing, infection, and posterior capsular opacification.
The method was used for over 100 years until the 19th century when Intracapsular Cataract Extraction was introduced. And with further studies, better tools (surgical) and methods of extracting cataracts were developed, making the extracapsular cataract extraction method the better method, rendering the Intracapsular cataract extraction method redundant.
Over time, however, the Intracapsular cataract extraction method was also rendered redundant because of the high rates of blinding complications. Important to note is that the modern-day versions of extracapsular extraction and manual small incision cataract surgery have been adopted in many parts of the world.
What Is Optical Biometry In Ophthalmology?
Optical Biometry is a non-invasive automated procedure used in ophthalmology to determine the anatomical characteristics of the eye.
What is Biometry for Cataract Surgery?
According to medical literature, the latest technology for cataract surgery is optical biometry devices, a procedure that has proved to be a highly accurate and non-invasive automated method for measuring the anatomical characteristics of the eye. The importance of accurate measurements is to help determine the IOL’s correct power before it is implanted when performing a Cataract surgery.
What’s more, is that ophthalmic Biometry is easy to perform and highly comfortable for the patients. Notable is that before implantation takes place, the specialists must first ascertain the correct power lens. And the method for determining the anatomical characteristics of the eye necessary for IOL power calculation is known as Ocular Biometry.
Ocular Biometry evaluates the axial length, anterior chamber depth, and Keratometry. Ocular Biometry also includes the anterior segment biometry that only measures the front third of the eye. The biometric measurements are important when it comes to selecting the correct IOL power and enabling the achievement of the relevant refractive outcome after the performance of cataract surgery.
What Tests Do You Need Before Cataract Surgery?
There are a couple of routine pre-operative tests performed before conducting a cataract surgery; for starters, your doctor will review your medical history and symptoms and proceed to perform an eye examination. Other tests that will be conducted are as
- The Visual Acuity Test– the visual acuity test utilizes an eye chart. And it measures how well a person can read a series of letters. The eyes will be tested one at a time while covering one of the eyes. And with a chart or a viewing device and progressively small letters, the doctor will determine if the patient has 20/20 vision or if the vision shows signs of impairment.
- The Slit Lamp Examination– is a procedure that lets the doctor view the structures at the front part of the eye but under magnification. The slit lamp uses an intense line of light, a slit that will help illuminate the individual’s cornea, lens, iris, and the spaces between the Iris and the Cornea.
- Retina Examination involves the doctor putting drops in the eyes of the patient to dilate the pupils, making it easier to examine the back of the retina. The doctor could also use the Ophthalmoscope to examine the lens for possible signs of cataracts.
- Applanation Tonometry– is designed to measure fluid pressure in the patient’s eyes, notable is that there are a couple of different devices that can be used to do this.
Important to note is that the American Academy of Ophthalmology does not encourage routine medical tests to be carried out before cataract surgery. The tests can, however, be carried out about the findings on a patient’s history or physical examination. Also, the American heart association discourages routine testing in asymptomatic patients who are about to undergo low-risk procedures such as cataract surgery.
Cataract Surgery Equipment
Just as the methods of performing Cataract surgery have evolved over the years, so have the equipment used to carry out the surgeries. Currently, the latest equipment used in Cataract surgery is the Trifocal lens which improves the patient’s vision at greater distances. Other Cataract Surgery equipment is the 12 tissue forceps, which hold delicate tissue such as the scleral flap. We also have the Utrata Capsulorhexis Forceps, which are used together with the phaco chopper to rotate the nucleus halves.
The Mcpherson Angled Tying Forceps enable an automatic way of holding, stitching, and retracting tissue when performing a Cataract surgery.
What is the impact of Cataract surgery on the quality of life?
Cataract surgery has been established to improve vision-specific functioning. However, the impact of Cataract surgery on overall health is not yet clear because of limited vision-related items. According to Ophthalmology literature, Cataract surgery improves visual functioning in individuals with comorbid eye disease, especially in its early stages.
Also, individuals who have undergone the second eye Cataract surgery have improved visual ability compared to the first eye surgery. And in recent developments, there has been a massive move toward second-generation Cataract surgery, which has exhibited significant gains in visual functioning. What’s more, is that the measurement precision has also been improved more so when compared to the types of equipment used in the first generation.
What Is the Content and Cost of Cataract Surgery?
It is almost impossible to estimate the cost and cost-effectiveness of the Cataract surgery procedure simply because there might be other recurring costs that cannot be generalized. Therefore there are a couple of methods by which the relevant personnel can estimate the cost of cataract surgeries. Overall, however, the below information will be required when estimating the cost of Cataract surgery.
- The ophthalmic process used- the ophthalmic process used in the surgery contributes to the overall cost of Cataract surgery but in the modern methods used for the surgery, such as phacoemulsification or minor incision surgery.
- Secondly, the cost of the consumables must be determined, including things like a syringe, dye, gloves, the intraocular lens, liquids for scrubbing, and balanced salt solution, among others.
- The cost of the operation theater procedures must also be determined, including maintenance, electricity, manpower, salaries, and the cost of the building.
- Costs will also accrue because of the time spent by surgeons and the average time required to spend on surgery. The above will be estimated in either a public or a private setting.
What are the complications of Cataract Surgery?
There are complications that arise after the performance of Cataract surgery, but the good thing is that most of these complications can be treated. Important to note is that the risk of an individual developing a complication increases if they have another eye disease or a pre-existing severe medical complication.
Individuals with Cataracts must also know that their vision might fail to improve if they have underlying eye damage from other conditions like macular degeneration and glaucoma. Thus, as a rule of thumb, individuals are advised to treat their pre-existing eye conditions before they decide to have Cataract surgery.
Here are some of the risks that accompany Cataract surgeries;
- Loss of vision
- Secondary cataract
- Retinal detachment
- Individuals might also suffer from drooping eyelids.
At What Stage Should Cataracts Be Removed
The realization that one has Cataracts can cause panic but that does not mean that it should be removed immediately. Besides, there are many people who have Cataracts but don’t experience blurred vision. Thus individuals who have Cataracts but can remain productive should not have their Cataracts removed. But individuals who have Cataracts and experience blurred vision when reading or driving should have their Cataracts removed.
Comparative Prices of Optical Biometry Devices for Biometric Calculations of Eye
Here are Optical Biometry Devices and Cataract Surgery Equipment for Eye Care.
1. Alcon Constellation ($11,999.00)
The CONSTELLATION Vision System is a microsurgical unit for cataract and eye surgery. Manufactured by American Swiss company Alcon, it is an innovative product in the world of vitreoretinal purposes.
The CONSTELLATION has a ton of features and functions.
New ULTRAVIT high-speed probe
The CONSTELLATION comes with the brand new ULTRAVIT high-speed probe. This feature allows cutting rates of up to 5000 CPM (cuts per minute). It gives surgeons an advantage for precise operations in vitrectomy procedures.
Duty Cycle operation
The CONSTELLATION also features a duty cycle control in a commercial-grade vitrectomy device for the first time. This allows surgeons to use different duty cycles for smooth vitrectomy procedures.
The CONSTELLATION has a fully integrated PUREPOINT® laser for optimal operation. This 532-nanometer laser allows surgeons better control and precision during surgical procedures.
Improved illumination system
The CONSTELLATION Vision System features improved illumination from its predecessors. This advanced Xenon illuminator comes in handy during tissue visualization. And it provides more prolonged and higher brightness lighting during such procedures.
Intraocular pressure control
Another standout feature of CONSTELLATION is the Intraocular pressure (IOP) control. This allows users to keep the infusion pressure in check, i.e., within 2 mm Hg. Thus, it results in a more stable intraocular pressure.
Table Top is the primary user interface. Therefore, it operates as a standalone unit and controls the add-on accessories. The accessories or customizations include the Laser Module, Base, Auxillary Illuminator, and Tray Arm Assembly.
- Interactive 17-inch display
- Data card slot with 2GB memory card support
- Two connector columns for pneumatic probes and electrical handpieces
- Fluidics module for easy insertions of cassettes
- Supports two types of Doctor Protection Filters when using the laser: Tethered and Non-tethered
- Barcode scanner
- Limited one-year warranty (three years for the laser module)
2. Alcon Centurion ($17,777.00)
The CENTURION is a phacoemulsification unit for use in vitrectomy procedures. Packed with the latest technology and design, it is another landmark achievement for Alcon. This CENTURION surpasses their previous product line from versatility to ease of use.
What are the main features of the Alcon CENTURION?
The CENTURION packs many features useful in cataract lens extraction and anterior vitrectomy. Here are its main features and highlights.
Active Fluidics Technology
The CENTURION offers the latest Active Fluidics Technology for stable procedures. This tech is more advanced and performs better than a gravity-based Fluidics system.
Balanced Energy Technology
The Balanced Energy Technology of the CENTURION offers an elegant and smooth performance. Surgeons can carry out phacoemulsification procedures efficiently with more control. The OZil phaco and INTREPID Balanced Tip make this possible.
Another highlight of CENTURION is its versatility in integrating with other technologies. This unit’s innovative design helps it blend well with other units for multiple configurations.
New Phaco technology
To add to its safety and consistency, Alcon introduced the INTREPID Hybrid Tip and ACTIVE SENTRY Handpiece in 2019. These new products are a step up from the existing OZil Phaco and INTREPID Balanced Tip.
The AutoSert IOL Delivery System in the CENTURION is another feature essential during cataract procedures. This injector allows smooth and consistent delivery of IOL. And this happens at predetermined speeds for single-hand insertions.
The software settings on the CENTURION also offer surgeons a wide array of settings. You can set the vacuum control, aspiration rate, etc., for flexible control and removal of cataracts.
- Large LCD touchscreen display
- Ergonomic design
- Wireless footswitch
- Motorized I/V pole
- Adjustable tray
- Storage drawer
- Rotating work surface
3. Bausch and Lomb Stellaris ($4,535.00)
Are you looking for an established technology that does not fail to impress? With Bausch and Lomb Stellaris, you are guaranteed the ultimate visibility powered with optimum precision. Why? Because the Stellaris is highly versatile as it is simple yet advanced in performance.
Many ophthalmologists who work on both the anterior and posterior parts of the eye find it challenging to get hold of a device that can suit their needs. This is where something as innovative as a Bausch and Lomb Stellaris comes into play.
Why choose Stellaris?
The Stellaris by Bausch and Lomb is an innovative machine that works wonders. It makes microincision cataract surgery so much easier due to its relatively advanced technology.
The Stellaris provides flow and vacuum fecal performance with a single aspiration system. Moreover, it balances fluid inflow by continually monitoring changes in a vacuum and adjusting its aspiration to prevent post-occlusion surges. The machine helps preserve chamber stability throughout the surgical procedure.
Considering all the positives of the Bausch and Lomb Stellaris, it should now be noticeable how the machine works differently than other kinds of the same. Eye cataract surgeries have and will experience a new wave in overall functionality.
Heidelberg Anterion is a relatively new introduction to the eye surgical devices of Heidelberg Engineering. It is a device developed to examine the anterior segment of the eye in surgical procedures.
Heidelberg Anterion is a one-in-all device that combines corneal topography and tomography, axial length measurement, intraocular power calculation, and anterior segment metrics.
Key benefits of the Heidelberg Anterion
- The device provides high-resolution images for all biometric measurements.
- It can give you still images with the required color and description in high quality.
- The device is also easily upgradable for efficient workflow.
- It has a high-speed acquisition performance while minimizing the time for the procedure.
- It can acquire ray tracing with minimum errors with just one setting.
5. Zeiss IOL Master 700 ($12,999.00)
IOLMaster 700 is the leading technological product in innovation and design in the realm of optical biometry devices.
The product manufacturer has also affirmed that the IOLMaster 700 can probe almost 99% of the cataract within the eye. This means that for the first time, the surgeon or medical examiner can see and observe what he/she is measuring. In addition, the powerful Optical Coherence Tomography (OCT) technology provides the ability to see the fovea, cornea, and lens without hindrance.
6. Keeler Accutome A-Scan Plus Connect ($2,390.00)
Accutome A-Scan or A-Scan Plus Connect is a revolutionary ophthalmic device from Keeler-Accutome. It’s a piece of equipment built to fulfill the requirements of present-day refractive cataract surgery. With the latest features incorporated into the machine, it’s one of the foremost products on the market.
Professionals in the ophthalmology field can use the machine easily by following simple instructions. It can also conduct multiple tasks without glitches. What’s more, you don’t waste much time performing the tasks.
Primary Functions of Accutome A-Scan
The equipment is an ideal solution for doing several tasks. They include
- Measuring and calculating all kinds of eyes
- Refining practitioners’ surgical outcomes
- It performs well with thick cataracts
- It also works great with patients who have fixation difficulties.
7. Nidek AL-Scan ($4,825.00)
NIDEK has produced a state-of-the-art machine designed and manufactured with precision, clinical competence, and ergonomic features. It enables uncomplicated measurement of six clinical parameters: corneal curvature radius, central corneal thickness, axial length, white-to-white distance, anterior chamber depth, and pupil size.
Using the NIDEK AL-Scan, these foundational elements, crucial for successful cataract surgery, can be executed in 10 seconds.
These are then extended out into the cornea, making the anterior segment visible to the one operating the machine.
- The sectional lens image helps assess the severe condition of the cataract.
- The pupil image helps assess multifocal Intraocular Lens (IOL) when scanning patients with myopia.
- The reflected image of the double rings helps detect anomalies on the corneal surface.
8. Lenstar Myopia ($7,900.00)
Lenstar Myopia consists of the Lenstar 900 optical biometer developed by Haag-Streit and the corresponding EyeSuite software as an extension. This device detects early myopia in patients to help make their daily life easier.
Features of Lenstar Myopia that make it easier to work within the optical industry.
Comprehensive Myopia Management
EyeSuite is software that is highly customizable and easy to use. However, it is also a very comprehensive tool for myopia management. Together with Lenstar LS 900, it is used to determine early myopia, its effects, and its consequences in patients.
By early determination of refraction in children, experts can predict the progression of myopia into their adult age. The EyeSuite software analyses this data with the predicted course with various treatment methods.
Axial Length Measurement
The measurement of the axial length is very important in the case of myopia. It is a great indicator of myopic progression as it is independent of the patient’s state of mind or willingness to cooperate in the procedure.
Determining Environmental Factors:
Lensar Myopia provides to define these environmental factors and their impact on myopia progression. It analyses these impacts based on recent research findings and visualizes their changes over a period of time.
A huge plus point of Lenstar Myopia is the graphic visualization of patient data. Graphic visualization of refractive or biometric data is used to determine a suitable treatment procedure for myopic patients.
The Lenstar Myopia software outputs a highly informative report combining visual curves and other data. This report allows patients to quickly understand their reports to actively participate in their treatment.
Lenstar Myopia consists of the Lenstar LS 900 biometer. It is a well-established optical biometer that gives an accurate measurement of the axial length and keratometry, and other structures.
9. Lenstar LS 900 ($6,900.00)
Lenstar LS 900 is an optical biometer that accurately captures all dimensions of the human eye. It is used mainly in the case of IOL (Intraocular Lens) surgery, where the eye’s natural lens needs to be replaced by an artificial one.
Lenstar LS 900 gathers seven different types of measurements through a single scan. Some of them are:
- Lens Thickness
- Axial Length
- White to White
- Anterior Chamber Depth
Lenstar LS 900 software is the latest technology and is very easy to use on all patients. Compared with competitors whose software remains outdated even after upgrading, this device is easier to operate.
10. Alcon Argos Biometer ($18,555.00)
Argos biometer is an optical biometer designed to promote delivering precision in optical procedures. It is a contactless and non-invasive clinical biometer. It uses SS-OCT (Swept-Source Optical Coherence Tomography), the first biometer in the world to use this technology.
The Argos Biometer is used before IOL surgeries to determine the dimensions of a person’s optical lens. It provides accurate information even about the cloudiest cataracts. It delivers precise and quick measurements of 9 parameters that count during IOL selection.
Multiple parameters in one scan
The Argos biometer can cover the measurements of multiple structures in one scan; some of which are:
- Toric Axis.
- Lens Thickness
- Pupil size
- Central Corneal Thickness
- K values
- Axial Length (AL)
- Anterior Chamber Depth (ACD)
11. Ziemer Galilei G6 ( $15,555.00 )
Galilei G6 is an advanced optical biometer used by optical surgeons for precision in optical procedures. It is also called a corneal topographer. It is a device that can be used both for cataract patients and patients who need refractive surgery.
Features of Galilei G6
In the context of making ophthalmologists’ work more accessible, here are a few features of this optical biometry devices device that make it so preferable:
- All-in-one Solution
The Galilei G6 device is the only device to combine Placido Disk Topography, Scheimpflug tomography, and Optical Biometry.
- Superior IOL Calculation
The Galilei G6 provides a dataset for IOL calculation and lens selection. With dual-Scheimpflug imaging, Placido, and lens measurement, this device’s lens selection process is more straightforward.
12. Sonomed Vupad (
Sonomed VuPad is the first and only tablet-based eye definition ultrasound device manufactured by Sonomed. It configures A-scan, B-scan, UBM probes, and pachymetry for ophthalmic ultrasound procedures.
The device comes in two types: wall-mounted and desk clamp, making it even more convenient. This is one unique feature of the VuPad, as most other devices come in only one variant.
The VuPad is designed to produce superior image quality with high reliability. Its ophthalmic ultrasound performance is one to be impressed by.
Why choose Sonomed VuPad?
If you choose Sonomed VuPad to accompany your surgical procedures, you will get multiple benefits from just one easy-to-use and compact device. With its unsurpassed image quality, you will receive precise details for accuracy.
The available preset scan modes will give effortless optimization and a multi-touch screen option for efficient results. This device is what the future of ophthalmology will need.
Overall, the Sonomed VuPad offers a perfect user interface to ensure great success in ophthalmic ultrasound. Its simplicity in design and interface is what makes this device so worthwhile.
For as much as there are stages when Cataracts should be removed, we cannot ignore that the longer a Cataract grows, the more it hardens. In this case, an advanced Cataract might prove challenging to remove. Cataracts should not be allowed to develop for extended periods because they can cause inflammation or Glaucoma.