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Friday / September 25.
Homemicontact2020: It’s Been Quite a Ride

2020: It’s Been Quite a Ride

We’ve only just reached August yet 2020 has already given us cause to take stock, focus on what really matters and what’s important going forward.

None of us would say 2020 has been an uneventful year… it has tested people on many fronts.

Some have coped, some have excelled, others have unravelled. Fortunes, goals and more have changed. The world is different.

I do hope that out of this, our understanding of, and empathy and respect for our fellow humans, animals and the environment, has taken a positive step forward.

Like all things that surround tumultuous events, time will tell.

In order to truly appreciate the magnificence of cataract surgery, you really need to sit in with your favourite surgeon… from the welcoming cup of tea to the postsurgery sandwich

A TIME FOR REFLECTION

I was reflecting on recent events one evening when cataract surgery – and its positive impact on quality of life – somehow entered my sphere of consciousness.

In order to truly appreciate the magnificence of cataract surgery, you really need to sit in with your favourite surgeon and watch the surgery through the operating microscope. Be there for the whole process; from the welcoming cup of tea to the post-surgery sandwich. Of course, one can also watch surgery on YouTube, but it’s not quite the same.

I’ve had a long interest in cataract surgery. I cut my teeth fitting aphakes, post-op, with contact lenses well before intraocular lenses (IOLs) became mainstream. Fitting a 94-year-old with dementia with their first contact lens was no walk in the park.

More than once a spouse asked me why their partner went into cataract surgery quite normal and came out ‘senile’. I asked an anaesthetist who explained that general anaesthesia required for cataract surgery in those days, and related oxygen deprivation, were the reasons. She suggested 24-hour postop oxygen as a solution. Today it’s all done and dusted in twenty minutes with, in many cases, local anaesthesia delivered via eye drops, a conscious (albeit sedated) patient, and a self-sealing, stitch-free surgical port.

Back then a patient would also be advised to stay in bed on their back, for a week or two, in order to reduce the risk of posterior vitreous or retinal detachment, as there was no lens capsule or IOL to keep it all in place!

Endothelial cell loss, oedema and corneal decompensation were not uncommon.

For most aphakes, a contact lens was a great success post cataract surgery. It avoided the complications of wearing very heavy, thick, +20.00D, glass single vision or bifocal spectacles, often with masses of anisometropia, Jack-in-the box ring scotomas and related falls. Most did well and many wore contact lenses from their 60s and 70s for more than a decade.

PIONEERING PEOPLE, PIONEERING TECHNOLOGIES

One of the methods used for large incision intracapsular cataract extraction was pioneered in 1965 by Johannesburg ophthalmologist Percy Amoils. He invented the cryoprobe, which is still used in eye surgery today, to remove the whole lens and capsule from the eye, in one piece.

Viscoelastics revolutionised cataract surgery. They were pioneered by Pretoria ophthalmologist Robert Stegmann circa 1980, around the same time I entered practice.

Within, and connected to our profession of eye care, we have incredibly positive people providing much to the less fortunate

Foldable IOLs were the next step in the revolution of what has become one of the safest, most widely practised surgeries. More recently, femtosecond laser-assisted cataract surgery added another dimension of technical wizardry.

When IOLs came along we rejoiced. They were pretty basic then and patients were often left with residual astigmatism – either surgically induced from a wide incision or due to the fact that there were no toric IOLs and thus refractive (corneal) astigmatism remained.

Today, Australia has among the highest levels of toric IOL prescribing in the world and complications are rare. Targeted endpoints are usually spot on, ably assisted by amazing biometry and calculators – like the widely used Barrett Formulas, developed by Perth ophthalmologist, Graham Barrett.

We see similarly impressive outcomes from mega-skilled vitreo retinal surgeons. They can peel micron-thin membranes off the macula, remove floaters and vitreous opacities, repair torn retinas with lasers and re-attach them with heavy liquids and gas bubbles in the eye. Remarkable!

KEEP THE VISION

I am in awe of these surgeons who provide the gift of sight. Their extraordinary work helps me focus on the ‘light at the end of the tunnel’, beyond the doom and gloom of some of the harsh realities that have created much angst of late.

But it’s not only the surgeons that we need to appreciate. Within, and connected to our profession of eye care, we have incredibly positive people providing much to the less fortunate. Volunteers, philanthropists and industry professionals deliver eye care and cataract surgery to remote regions around the world. Australia has – through people like Fred Hollows, Brien Holden’s vision and the work of the Brien Holden Vision Institute – led the charge to eradicate preventable blindness in the world. Furthermore, Australians and New Zealanders have pioneered myopia control with orthokeratology and multifocal contact lens technology.

Thank you, one and all.

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