Talk:Cataract surgery
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[edit] Comment
This page distinguishes polymethyl methacrylate lenses and sodium acrylate lenses from acrylic lenses. However, "acrylic" is a term that is commonly used as a synonym for polymethyl methacrylate (tradenames Plexiglas and Lucite). If it is not being used as a synonym, it means a more general concept which would include both polymethyl methacrylate and sodium acrylate (with which it is also being distinguished).
An edit is reccommended.—The preceding unsigned comment was added by 140.203.154.12 (talk • contribs) 15:02, 28 September 2005 (UTC).
[edit] History?
We need something on the history of this procedure. When did man first try to remove cataracts? How did the procedure evolve into one of the safest? Lou Sander 03:07, 28 May 2006 (UTC)
- I made a start with it. --WS 11:20, 28 May 2006 (UTC)
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- Thanks. I've been wondering what they did about anesthesia in the early days of modern cataract surgery. Also, family members recall from the 1940s and 1950s that patients' heads were immobilized for quite a while after the procedure. This might be a good addition to the history. Lou Sander 11:11, 20 July 2006 (UTC)
[edit] Safety and efficacy
The opening paragraph includes the statement "It is one of the safest and most successful procedures in all of medicine". This seems to be a rather bold statement to make without any data referenced to back it up. --151.190.254.108 12:37, 18 August 2006 (UTC)
- I agree. Although what constitutes "safe" and what constitutes "effective" is certainly open to a bit of interpretation, I have added a citation that backs up the statement. -AED 16:20, 18 August 2006 (UTC)
[edit] Structure of this and related articles
[Note: I am not an medical professional, but a 54 year old IT professional who understands the process of structuring this type of content, but more importantly has recently had phaco based replacement of both lenses due to early onset cataracts, so I understand very well how this all feels from the other end of the knife ----]
I see that you've been tidying up and improving this article but I still feel that is structure and relationship to other articles needs tidying further.
First Types of surgery: you've got three broad types of surgical procedure and this section should be structured accoundingly
- Phaco based ECCE
- Conventional ECCE
- ICCE
This is the correct order because it is ranked in order of usage. The Phaco summary should include the reasons for Phaco's popularity: efficiency and effectiveness of procedure and short recover times. Conventional ECCE and ICCE should include a short discriminant to explain when they are still used in preference to Phaco.
Intraocular lens implantation is not a type of surgery but a common stage in all three procedures. It therefore does not belong in Types of surgery but in its own following section. I did wonder why ths merits its own section but the real reason for it being here is to summarise very briefly the IOL options, and to hook to the IOL article itself for the detail. This hook should also explain that the IOL section will discuss the optic characteristics of the various options (which it currently doesn't BTW).
This section currently includes detail on complications, which doesn't belong here. This needs to be consolidated with the discussion in the Operating Procedures or Complications sections.
Likewise Intracapsular cataract extraction is a type of surgery and this test should be hoisted into the above bullet.
Preoperative Evaluation Gosh you can tell that this article was written by doctors for doctors. You've forgotten the most important part of the eval from the patients perspective: you need to do the biometry so that the IOLs are correctly proscribed for the patents needs.
Operating Procedures also wanders into Post Operative Care and Recovery. This need split into two separate sections. First the procedures themselves miss some key points such as it being absolutely essential that the patient remains still during the procedure, and therefore depending on anxiety level different forms of local anaesthesia and mild sedation may be appropriate and in the extreme general anaesthesia be in the best interests of some patients. [Isn't this uncontrolled patient movement one of the main factors in posterior capsular tears?]
Also I do think that you should elude to the visual effects experience by patients as they watch their lenses being liquefied and removed "from the inside" -- this is a truly bizarre (almost psychedelic) and disturbing experience.
Somewhere you should discuss the appropriateness of AK which is currently omitted.
Next the Post Operative Care and Recovery should be structured chronologically, first discussing immediate post op. For example in my case the dilation drops dilate the pupil larger than the diameter of the IOL allowing unfocused light to pass directly onto the retina, causing a degree of white-out / loss of contrast for about six hours past the op and somewhat similar to the opification caused by the cataracts themselves -- very disturbing until I worked out the optics of what was going on here. Secondly the typical recovery times for iris function. It took over 24 hrs before the iris returned to approximately normal diameter, and about 4 weeks whilst its responsiveness was degraded causing some degree of photophobia. This is the point to discuss anti-inflammatory and antibiotic drops ,and cleaning regimes to avoid fungal as well as antibiotic infection.
And one final point is the issue of the changing corneal geometry -- particularly for the first two months after the operation -- and the impact this may have on any corrective prescriptions. For someone like myself with ~1.5D of astigmatism pre op, and needing to read / write 8+ hrs a day on a PC this was a real strain and issue.
[Though I have quoted my experiences in this discussion, I am not trying to personalise the article itself. I accept that this article should remain largely written by medical professionals, but acknowledging that vast majority of readers will be cataract sufferers or their relatives. We should address their potential concerns. If I as a cataract sfferer experience these issues, then they might be common enough at least touched on in the article. However, if the main drafter are interested I can mock up my proposed new structure in my sandbox sothat you can see a draft the overall changes]
One final point: the IOL article needs major change to align with this but I will discuss this in said article. TerryE 02:25, 21 July 2007 (UTC)
[edit] Two eyes in the same day
Mention if two eyes are ever operated on on the same day.
- Then how will you get home?
- But at a remote rural once a year clinic (if there is such) in a impoverished country, maybe it would make sense.
Jidanni 10:58, 28 September 2007 (UTC)
[edit] "ambulatory"
ambulatory (rather than inpatient) setting
whereupon you commence to lose the reader in a forest of fancy unlinked words throughout the remainder of the article. Ambulatory must mean in an ambulance, he thinks. Great :-( Jidanni 11:06, 28 September 2007 (UTC)
