ophthalmology

High-tech innovation and advanced surgical techniques have transformed the field of ophthalmology, with new treatment options making surgery faster and more accurate. We speak to Professor Rudy Nuijts, a leader in the field of cataract surgery, about the radical changes he has seen and what the future may hold. How has cataract care changed since you began working as an ophthalmic surgeon ? I was trained in extracapsular surgery which involved making incisions of at least 6mm to remove the patient’s lens. In the early 1990s, ophthalmologists in the Netherlands started to embrace phacoemulsification – a new alternative where the lens is broken into tiny fragments using ultrasound energy before being removed. That changed everything. How did these advances help patients? The recovery process was much faster and there was less post-operative astigmatism . Since then, technology has improved further: the machinery we use results in a more stable anterior chamber, with less risk of posterior capsule rupture and there is much more choice and versatility in the range of lenses available for implantation. Are there other technological advances that have improved outcomes for patients? The introduction of multifocal intraocular lenses (IOLs) has meant patients can be spectacle-independent after cataract surgery. Instead of just fixing the cloudy vision caused by their cataract, patients can now have a refractive lens implanted which improves their vision. These include toric IOLs which allow us to correct astigmatism and make patients spectacle independent for distance. Another big leap forward has been multifocal lenses. Most surgeons in Europe have, over the last year or two, moved from bifocal to trifocal lenses. This has big advantages for patients. For example, with multifocal trifocal lenses they can read at intermediate distances – for iPads or reading a computer screen, this is a distinct advantage. Bifocal lenses were...
The range of treatment options for patients with vision problems has expanded dramatically over the past two decades. This has helped to improve outcomes for patients while delivering shorter recovery times. But with so many possibilities available for vision correction, cataract removal and glaucoma surgery, how can patients make informed decisions that give them the best chance of getting the result they expect? While some turn to the internet or rely on the experiences of friends and family, the role of experienced ophthalmologists in demystifying treatment options is now greater than ever, according to Professor Carlos Palomino Bautista, Head of Ophthalmology Services, at the University Hospital of Quirón in Madrid. He says his long career in ophthalmology can be divided into two periods – the era before patients had the internet, and the period thereafter. Each has its own pros and cons. “Patients are increasingly aware of what is possible. We have a lot of patients that come to a consultation with information found online,” he says. “They often have a particular lens or procedure in mind but sometimes, after examining them and discussing the specifics of their case, I help them to change their mind.” Every patient is different. Not only can age, vision and the physical characteristics of the eye vary considerably from one patient to the next, their needs differ depending on the kind of job they do and how they spend their spare time. For example, ophthalmic surgeons can now implant corrective lenses in the eye during cataract surgery. But deciding which one requires a detailed conversation between patient and surgeon. “For a patient with long-sightedness, who has glaucoma or macular degeneration, there is a specific lens that I would choose,” says Prof Palomino who is also Professor of Ophthalmology at the European University of Madrid...
The treatment options for people with vision problems have changed dramatically over the past decade. New technologies have improved outcomes, reduced patient discomfort and brought an unprecedented level of choice for patients. We spoke with Dr Kaweh Schayan-Araghi, a consultant ophthalmologist at Artemis Klinik in Germany, about the progress he has witnessed and what the future may hold. How have treatment options changed for your patients? Over last ten years or so, the treatments available have improved for people with myopia (short-sightedness), astigmatism (defect in the eye resulting in distorted images), and cataract (a clouding of the lens). Looking back, the options for patients with astigmatism were especially few for those with low or moderate astigmatism – interocular lenses were really only used for people with much higher astigmatism and it was quite difficult to get a precise correction. Limbal relaxation incision was also used to correct astigmatism. This involves cutting into the cornea but, to be frank, the outcome was quite unpredictable and uncomfortable for patients. Most endured itching, rubbing and a feeling that there was something in their eye for three or four weeks. What is available today? The most dramatic change has been the evolution from implanting just clear lenses to implanting a refractive lens which actually corrects vision: we are now addressing cataracts and correcting vision in a single surgery. This would previously have required two separate operations. So, in a lot of cases we are not just clearing the cataract, the patient could be rid of glasses or have reduced dependency on glasses for the first time in decades. What kind of attitudinal shift have you seen in ophthalmology? In the past, the goal of surgery was to improve ‘best corrected vision’. This implies that patients continue to wear glasses. Today, surgeons want to achieve...
People with a rare eye disease known as retinitis pigmentosa (RP) suffer a gradual loss of vision; some become completely blind. Now, an innovative new approach to treatment has given dozens of people the chance to see again. With the help of a retinal implant, special glasses and intensive training, people who were blind have a new way of viewing the world which could one day benefit people with other degenerative eye diseases. We spoke to Professor Marie-Noelle Delyfer, University Hospital of Bordeaux, who has already performed eight such operations. What is retinitis pigmentosa (RP) and what is the prognosis for patients? RP is actually around 300 distinct genetic disorders that lead to the loss of photoreceptors on the retina. Some affected individuals have a reduction in their visual field while others become blind. With such a rare disease, it is difficult to describe a typical patient. Some lose their sight early in life or in early adulthood but there are others who become blind only in their 70s or 80s. Until 20 years ago, there were no treatments at all and the disease was not well understood. The first genetic cause of the disease was identified in 1984 – before that it was thought of as an inflammatory disease. What treatments are available? Some pharmaceutical therapies help to maintain photoreceptors but this only slows the progression of the disease – it’s not a cure. In the longer-term, there is some research on gene therapy targeting the mutations responsible for RP. How can technology help? I have used a new technology, from SecondSight, with eight carefully selected patients living with end-stage RP. These patients have an electrode array implanted in their retina. They wear glasses that are fitted with a camera that ‘sees’ their surrounding environment. This signal is sent...
High-tech innovation and advanced surgical techniques have transformed the field of ophthalmology, with new treatment options making surgery faster and more accurate. We speak to Professor Rudy Nuijts, a leader in the field of cataract surgery, about the radical changes he has seen and what the future may hold. How has cataract care changed since you began working as an ophthalmic surgeon ? I was trained in extracapsular surgery which involved making incisions of at least 6mm to remove the patient’s lens. In the early 1990s, ophthalmologists in the Netherlands started to embrace phacoemulsification – a new alternative where the lens is broken into tiny fragments using ultrasound energy before being removed. That changed everything. How did these advances help patients? The recovery process was much faster and there was less post-operative astigmatism . Since then, technology has improved further: the machinery we use results in a more stable anterior chamber, with less risk of posterior capsule rupture and there is much more choice and versatility in the range of lenses available for implantation. Are there other technological advances that have improved outcomes for patients? The introduction of multifocal intraocular lenses (IOLs) has meant patients can be spectacle-independent after cataract surgery. Instead of just fixing the cloudy vision caused by their cataract, patients can now have a refractive lens implanted which improves their vision. These include toric IOLs which allow us to correct astigmatism and make patients spectacle independent for distance. Another big leap forward has been multifocal lenses. Most surgeons in Europe have, over the last year or two, moved from bifocal to trifocal lenses. This has big advantages for patients. For example, with multifocal trifocal lenses they can read at intermediate distances – for iPads or reading a computer screen, this is a distinct advantage. Bifocal lenses were...
What is your day-to-day work like? I work in the Department of Ophthalmology at the Charles University Faculty of Medicine, Hradec Králové, Czech Republic, specializing in cataract surgery, refractive surgery, the treatment of retinal diseases and laser corneal surgery, amongst others. In fact, I carry out over 2000 cataract surgeries a year. I also deal with some of the most complex cases in the Czech Republic. I’m also focused on spreading my knowledge and educating the next generation of doctors specializing in eye conditions and care and I’ve been working internationally too, working with the American Academy of Ophthalmology for example, as well as co-operating with innovative companies to share experiences and advance research and knowledge. How do you help improve or save people's lives through your work? Eyesight is a precious gift. I may not save people’s lives physically by my work but I certainly help to improve and even transform people’s lives. I will never refuse any patient, whatever age, background or complexity, and will do my utmost to restore their sight. What challenges face the healthcare system? The major challenge facing healthcare is the enlarging gap between the advances in medicine and the costs involved. This is only set to increase as the demographics change. Indeed, age-related conditions are harder to solve. Healthcare systems will face huge problems trying to cope with older patients with neurodegenerative diseases for example, or Alzheimer’s. There needs to also be a major focus on addressing the treatment inequalities facing patients. Treatment should not be limited to only a few but to all and the latest in technology should ideally be available. What role do you see for medical technologies to address these challenges? Diagnostic tests can help to address these challenges, allowing people to be diagnosed early and accurately and therefore...