Observing Cataract Surgery

The Global Health Fellows in the 2018 and 2019 cohorts recently read and discussed an interesting case from the Center for Global Development on treating cataracts in India.  Following the case, the 2019 cohort traveled to Virginia Eye Consultants.  

Below is a reflection from Andrew Thetford, GHF ’19.

This past Tuesday, the 22nd of March, the 2019 Global Health Fellows had the privilege of watching two cataract surgeries and touring the facility that offers these services.  Our day at the Virginia Eye Consultants Center began with a tour of their amazing building, one of the nicest and most comfortable medical centers I had ever been to.  We viewed the many offices that are located in the building, including a newly renovated area that greatly increased the working space.  We were also shown to two different machines for diagnosing cataracts and other issues in the eye.  One was the Fundus Photo Camera, and the other was called an OCT machine.  Each device took detailed pictures of the back of the eye using high resolution photos, and these pictures could then be studied to examine the severity of a cataract or other problems.  

After our tour, we watched our first surgery. The first patient was a woman around 75 years old, and she was having surgery done on a cataract in her left eye.  This being my first time observing a surgery, I wasn’t exactly sure what to expect, but I was very amazed at what I saw.  The patient is awake the whole time, and is just given a pill to make them feel “as if they have had a couple of drinks,” as our guide explained.  They have to focus on a light directly above them during the entire surgery, which lasts 7-10 minutes, and they feel absolutely nothing during the procedure.  The surgeon began by lubricating the eyeball with fluid, then making two small incisions around and above the iris, the colored part of the eye.  After making these cuts, he sliced off the thin membrane that sits right above the lens of the eye, which itself sits right below the iris and can be seen through the pupil, the dark opening in the center of the iris.  He then removed this membrane with a very small pair of tweezer-like tools.  Now, the cataract was visible.  And like I said, I’m no cataract expert at all, but even I could tell that this was one old cataract.  It was very thick and dark, and really reminded me of the inside of a jelly bean in appearance and texture.  The doctor poked around for a little bit, then inserted a vacuum-like tool into the slits and began to extract the cataract.  Because of the thickness of the cataract, it took a while.  The cataract fell apart in chunks and was quickly sucked up by the tube.  After finishing, the doctor inserted the new lens into the opening.  The lens was rolled up like a contact, and sprung apart once inserted into the eye.  The new lens immediately improves vision, allowing the patient to perceive colors and details that they had not been able to in a long time.  

Our second patient was a little different.  A few years younger than the previous patient, this woman had had a laser procedure done on the cataract before actually having it removed.  This means that a precision laser device softened and cut up the cataract to make it easier to extract.  This combined with a younger and softer cataract made for a swifter and easier procedure.  

After finishing up with both patients, we finished our visit with a tour of the Pre- and Post-Op area.  This room was filled with curtained-off sections for wheelchairs and hospital beds.  One of the patients we had watched, who had just finished up with surgery no more than 15 minutes before, was already up and ready to leave.  We were also shown the laser machine that performed the preliminary procedure on the second patient.  It filled an entire room, and had several dials and buttons that made no sense to my cohort.  The operator of the machine, however, obviously possessed a wealth of knowledge and experience for how to operate the device, and gave us a very detailed overview of how it worked.

Our trip to the Virginia Eye Consultants was a great experience.  The 18’s and 19’s just recently finished a case study discussing cataracts in India, so this was an awesome way to experience it firsthand.  Additionally, several of us are interesting in further researching optical health in developing countries, so having learned about and witnessing cataract surgeries is not a bad thing to have under our belts.

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