Cataract Surgery Techniques

Cataract surgery is relatively simple, once the medical personnel is trained and is provided with proper tools. But, for years, the most sophisticated cataract surgery in the Third World consisted of intracapsular cataract extraction where the entire lens and capsule is removed from the eye and the patient must wear thick, crude eyeclasses for visual restoration. Unfortunately, these glasses give excessive amounts of distortion. In addition, there were few facilities for accurate refraction. Moreover, once a person loses, scratches, or breaks their thick glasses, they are again as blind as before the surgery. In fact, in Nepal, the second leading cause of blindness is aphakia due to lack of glasses after intracapsular surgery. The Himalayan Cataract Project concentrates on conducting cataract camps and training native medical personnel utilizing the extracapsular cataract extraction technique. With this technique, surgery is cost effective at about $20 per eye. But even with this improved technique, to keep costs reasonable, we are only able to provide people with 10 year old technology. State of the art surgery would cost $6,000.

With the extracapsular cataract extraction technique, the surgeon makes an incision where the cornea and sclera meet. Carefully entering the eye through the incision, the surgeon gently opens the front of the capsule and removes the hard center, or nucleus, of the lens. Using a microscopic instrument, the surgeon then suctions out the soft lens cortex, leaving the capsule in place.

An intraocular lens (IOL) is a clear plastic lens that is then implanted in the eye during the cataract operation. Lens implants have certain advantages. They usually eliminate or minimize the problems with image size, side vision and depth perception noted by people who wear cataract eyeglasses. They are also more convenient because they remain in the eye and do not have to be removed, cleaned, and reinserted as do contact lenses, a huge consideration in Third World areas.