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CATRACT SURGERY: Implantation of Artificial Intraocular Lens (IOL)

CATRACT SURGERY: Implantation of Artificial Intraocular Lens (IOL)

Dr Meena Doshi, Practising Ophthalmologist at her clinic Right Sight in Kemps Corner, Mumbai.
She has been graduated with an M.B.B.S. degree from Calcutta university in February, 1984 and after being relocated to Mumbai, she did her Post graduate study in Ophthalmology and got her D.O.M.S and F.C.P.S. qualifications in October, 1986 and March, 1989 respectively.
She is working in the field of Ophthalmology for the past thirty years and have rendered her services in charitable activities, attending eye camps and also seeing patients in charitable clinics.
At present she is an Honorary Ophthalmic Surgeon at Conwest and Manjula Badani Jain Hospital at Girgaum, Mumbai. Dr Meena’s special areas of interest are cataract surgery by Phacoemulsification and Glaucoma which is a silent vision threatening disease affecting our optic nerve due to usually high intra ocular pressure and Medical Retina where certain changes happen in the light sensitive area of our eye, due to systemic diseases like Diabetes or Hypertension and with age called Age Related Macular Degeneration.
With her partners they are giving high quality eye care to all their patients and also rendering the same high-quality eye care to the marginalized in our community with the help of their subsidized rates at camps and their centres in Kemps Corner and Vashi.
Having a chance to get into a conversation with Dr Meena Doshi, Partner at Right Sight Eye Clinic, our Editor-in-Chief Siddharth Salecha tries to understand how they conduct Cataract surgeries and what are the pre and post measures to be taken by the patients.

INTERVIEW:

What was your journey like? Also how did you achieve what you have today?

I passed my post-graduation in Ophthalmology in 1989 and have been working in the field more actively since 1995 after a sabbatical of almost 5 years after the birth of my son. I worked in charitable trust run hospital and gained my confidence and the following work experience improved my skills in a private run eye institute, where I got exposure to the latest state of art surgical skills. I started my private practice with 2 other partners Dr Bijal Mehta and Dr Prakash Nayak in April 2011 with which we have 2 centres one at Kemps Corner where I principally work from and the other is at Vashi. Challenges ah! Have been many as it is a field where one has to keep oneself updated as technology evolves and one has to be abreast with the latest to be able to give the best to the patient. Looking back, I am happy that I have tried to do my best for my patients which is my reward.

What Services does your clinic provide?

Our Services include:
  • Comprehensive Eye Check-up.
  • Cataract Surgeries in our clinic OT.
  • Glaucoma Evaluation and Management.
  • Diagnosis and Management of Retinal Diseases like Diabetic Retinopathy and Age Related Macular-Degeneration.
  • Lasik & Refractive Surgery (Not in our clinic)
  • Paediatric Ophthalmology.

What is Cataract Surgery?

Cataract Surgery is when the natural transparent lens which has undergone opacification or has become hazy giving visual problems and interferes with one’s daily activities is removed and replaced by an artificial intraocular lens (IOL).

Can you list down major benefits of cataract surgery?

Restoration of vision, so patient is able to enjoy his/her daily activities with ease. Depending on the patient’s visual needs the type of IOL is chosen and patient’s dependence on glasses is reduced and he /she is comfortable with most activities for distance and near without the need for glasses. In some patient, cataract may increase in the eye pressure which is avoided when the cataractous lens is removed.

How long does it take to recover completely from the surgery?

Most of the patients recover and are happy with their vision on the first post-operative day though they can resume work after 5 days. However, one needs to take care for a period of 4 weeks post-operative with regular instilling of drops.

What is the procedure to follow pre and post the surgery?

Once the patient has decided to go ahead with the cataract surgery with his/her chosen doctor he/she is asked to do a few routine tests, If the tests are normal a test is done to determine the power of the IOL to be implanted called Biometry. An antibiotic drop is given to be instilled in the eye 2 days prior to surgery and at the day of surgery patient comes for surgery after a light breakfast in the morning. Post-operative patient has to put the drops given as per instructions. As we do the surgery under topical anaesthesia i.e. only by putting anaesthetic drops and no injection the patient goes home with protective glasses without a patch. Patients are instructed well before not to touch or rub the eye and also to instil the drops given as directed and visit the doctor as instructed. They should report immediately in case there is any pain redness or difficulty in seeing. The patient should avoid head bath for several days and also swimming, sauna, heavy exercise to be avoided for at least 3 weeks.

What are the things which one should avoid post the surgery?

Avoid head bath for 5 days. Swimming, Sauna and heavy exercise should be avoided for at least 3 weeks.

What are the indications for a patient to know whether cataract surgery is required?

  • Blurring of vision
  • Poor Night vision or needing brighter light to read
  • Sensitivity to light
  • Increased glare especially while driving at night
  • Double vision in any of one eye
  • Experiencing fading of colors

What is Glaucoma? How many types are present?

    1. Glaucoma is a group of diseases that damage the optic nerve of the eye usually but not always associated with increase in eye pressure.
    2. Types of Glaucoma
      • Primary Glaucoma is of 2 types
– Open angle Glaucoma when the drainage angle is open. – Angle Closure when drainage passage is narrow and prevents outflow of fluid.
      • Secondary Glaucoma.
– It is due to an underlying cause like trauma inflammation excessive use of steroids locally or systemically post-surgery.

How problematic can glaucoma be for the eyes?

Glaucoma is a serious disease as it is a silent disease and called the ” thief of sight “. Usually the patient has no serious symptoms and it produces an irreversible damage to the optic nerve fibres leading to loss of peripheral vision and in serious untreated cases loss of vision. However early diagnosis can prevent the damage and prevent serious vision loss, It is advisable therefore to have regular check-ups after the age of 40years so the treating doctor can pick up early signs. People with a family history myopes or history of trauma or on certain medicines like steroids one should have regular eye check-up.

What would you prefer as first choice for your patients, glasses or lenses? Why?

Glasses are the safest to correct vision, hence I suggest glasses over lenses. Here’s why: –
  • Contact lenses are given for cosmetic purpose usually but need adequate care as improper hygiene can lead to eye infection which can be vision threatening.
  • They also aggravate dryness in people with more screen time.

Is “work from home” an option for you? How do you tend to manage?

We cannot adapt work from home completely, though we can treat certain disorders by telemedicine and by pictures through WhatsApp or so. However, if there is a disturbance in vision, we need to see the patient physically.

How has COVID-19 affected or will affect your profession?

We are seeing very few patients with social distancing and due care so limiting the number of patients coming to the clinic has been strict. Surgery being elective we are operating only patients with significant visual disturbance with all necessary precautions. COVID 19 is going to be with us for some time and we have to find our way so that we can give our services with safety to both patients and our staff.

5 safety tips for our readers in relation to the increased screen time due to lock down or working from home?

  • For Screen time we say 20/20 i.e. work for 20 minutes and defocus for 20 minutes.
  • When we are seeing the screen, our attention is on our work which reduces our blinking so the eyes remain open leading to more evaporation of our tears which leads to dryness.
  • It is important to blink properly and close eyes so tears bathe the eyes.
  • Not to touch or rub the eyes.
  • Use lubricants if necessary.

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