Index

Astigmatism (Cont’d)

Blepharitis, 24

232

ATR, 113

Blink reflex, 126

axis misalignment vs. residual, 112f

BPH see Benign prostatic hypertrophy

clinical impact, 112

(BPH)

cornea, 85–86

B-scan ultrasonography, 27, 29

corneal topography vs. keratometry,

C

113

defined, 109

Capsular cataracts, 11

frequency, 112

Capsulorrhexis, 98f

future developments, 122

Cardiff Acuity Test, 192f

incisions, age and location, 116

Cataracts, see also individual cataracts

induced, 167

assessment of, 17–32

irregular, 36

causes of, 2–3

laser, 122

classification of, 5–14

limbal relaxing and corneal relaxing

definition of, 90

incisions, 115–118

effect on visual function, 18–19

marking steep meridian prior to

formation of, 2

surgery, 113–114, 114f

post-operative management,

oblique, 109

125–140

oblique position, 112

referral service level agreement,

on-axis incision, 115

219–221

preoperative assessment, 113

risk factors for, 2

pseudoaccommodative lenses, 77

Cataract surgery, 88–106, see also

ray tracing, 109f

Phacoemulsification cataract

surgically induced, 110

surgery

toric intraocular lens, 118–122

complications during, 139

combining toric IOL and incision

complications following, 141–182

techniques, 122

capsule rupture, 104

with-the-rule, 36

choroidal haemorrhage or

ATR see Against-the-rule (ATR)

effusion, 105

Atropine, 197

corneal, 104

Axial length measurements, 39–40, 41–44

incidence of, 144–146

B

indications of, 130

regional anaesthesia, 103

Bathing

daily activities following, 132

following cataract surgery, 132

direct optometric referral and share

Bell’s phenomenon, 126

care post-operatively, 210

Benign prostatic hypertrophy (BPH), 26

final review, 133–134

Bilateral nuclear opacities, 184

future of, 207–214

Bimanual phacoemulsification, 101

with glaucoma or vitreo-retinal

Biometry, 27, 29, 34

surgery, 136

corneal compression, 51

iris trauma, 160f

difficulties, 65

models of, 213

immersion, 51

patient expectations, 131

preoperative, 33–72

previous, 38

Cataract surgery (Cont’d)

abscess, 118

risks vs. benefits, 18

astigmatism, 85–86

233

selection for, 18–22

complications related to, 153–155

traditional model, 209–212

compression, biometric error, 49

training requirements for optometric

diurnal variations in physiology, 36

direct referral, 211–212

endothelial decompensation with

Centerflex toric intraocular lens, 119,

persistent or severe oedema, 154

119f

limbal tunnel incision, 96f

Central, steady and maintained (CSM)

mild edema, 153

system, 188

non-sphericity of, 37

Central cataracts, 188

oedema, 154

Cerulean cataracts, 14

pathology, 19

Chondroitin sulphate (Viscoat), 98

post-operative assessment, 130

Choose and Book, 213–214

power of, 34

Choroidal haemorrhage, 105

suture, 97f

Christmas tree cataract, 8

thermal burns, 104

Chronic obstructive pulmonary

topography, 27, 29

disease, 25

wound burn, 146

Closed suprachoroidal haemorrhage,

Corneal relaxing incisions (CRI), 115

173

vs. LRI, 116

Coexisting ocular conditions

Coronary cataracts, 13

predicting cataract surgery

Cortical cataracts, 6

outcomes, 19

decreased contrast sensitivity, 7

Coexisting retinal disease progression,

driving difficulties, 7

174

Cotyledons, 8

Community post-cataract operation

Couching, 90

report form example, 228–230

Cover test

Complete cataracts, 12

binocular alignment, 189f

Confrontational visual field

Craniofacial abnormalities, 185

examination, 24

CRI see Corneal relaxing incisions

Congenital cataracts, 12–13

(CRI)

morphological classification of, 12

Crystalens, 75, 75f, 82

Conjunctival chemosis, 150

CSM see Central, steady, and

Conjunctival inclusion cysts, 104

maintained (CSM) system

Conjunctivitis, 24

Cystoid macular oedema, 135, 169–170

Contact echogram, 54f, 56f, 58f

Cytomegalic inclusion disease, 194

Contact lenses, 36–37

D

aphakic child, 201

hydrogel, 202

Daycase surgery, 93, 93f

rigid gas permeable, 202

DC see Dioptres of cylinder (DC)

silicone, 201

Descemet detachment, 147

silicone hydrogel, 201

Descemet’s membrane, 104

Contact ultrasonography, 50f

Dexamethasone

Cornea, 138

following cataract surgery, 132–133

abrasion, 155

Diabetes, 25, 136

Diabetic retinopathy, 20, 21

Echogram, 48

234

proliferative, 20

contact, 54f, 56f, 58f

Diamox, 127, 137, 176

ideal immersion, 52f

side effects of, 127, 179

immersion, 55f, 56f

Diet

interpretation, 51–53

following cataract surgery, 132

Electrolytes, 194

Diffraction

Elschnig pearls, 76, 163

altering angle, 77

Emmetrope, 74, 131

grating, 77, 78f

Endophthalmitis, 146, 156, 157f

Diffractive lenses, 77

following cataract surgery, 133

Dilating eye drops, 197

following paediatric cataract surgery,

Dioptres of cylinder (DC), 110

199

Diplopia, 180

Endothelial decompensation with

Direct illumination

persistent or severe corneal

PSC, 9

oedema, 154

Direct ophthalmoscope

Epikeratophakia, 201, 203

retinal red reflex, 187f

Erbium:YAG laser, 101, see also Yttrium

Directorate of Optometric Continuing

aluminum, garnet (YAG) laser

Education and Training

Expulsive choroidal haemorrhage,

(DOCET), 216

105

Direct referral form example, 225–226

Extracapsular cataract extraction

Discharge instructions, 130–132

(ECCE), 100

Distance visual acuity, 27, 28

Extraocular movements, 180

Divide and conquer technique, 99, 100f

Eye

DOAS see Do Once and Share

axial length of, 29, 34

(DOAS)

cleaning, 133

DOCET see Directorate of

pads/shields, 126

Optometric Continuing

Eye drops

Education and Training

dilating, 197

(DOCET)

Eyelid-related complications, 177

Do Once and Share (DOAS), 214

Eyepieces

Down’s syndrome, 13

failure to focus on, 37

Driver and Vehicle Licensing Agency

F

(DVLA), 23

guidelines, 132

Fixation test, 10-PD, 188

Driving

Flashing lights, 138

following cataract surgery, 132

Flomax, 26

Drug allergy, 178

Fluorescein, 129

Dry eyes, 24, 47

Fluorescein angiography, 170

DVLA see Driver and Vehicle Licensing

Focusing on objects

Agency (DVLA) guidelines

PSC, 9

E

Foldable intraocular lens, 102, 102f

implants, 92–93

ECCE see Extracapsular cataract

Fresnel prisms, 181

extraction (ECCE)

Frisby test, 191, 192, 195f

Fuch’s dystrophy, 25

HPMC see Hydroxypropyl

Fundus, 22

methylcellulose (HPMC)

235

G

Human Optics 1CU, 75, 76f

Hydrodissection, 99f

Galactokinase, 195

Hydrogel contact lenses, 202

Galactosemia, 185

Hydroxypropyl methylcellulose

Gas permeable (GP) contact lenses,

(HPMC), 98

202

Hypertension

Genetics

systemic, 25

paediatric cataracts, 195

Hyphaema, 151, 151f

Glare

I

cortical cataracts, 7

from lens-edge effect with square-

Ibuprofen, 127

profile IOLs, 168

Ideal immersion echogram, 52f

PSC, 9

IFIS see Intraoperative floppy iris

Glaucoma, 19, 137, 175–176

syndrome (IFIS)

after cataract surgery, 136, 175

Immersion biometry

after paediatric cataract surgery, 198

corneal compression, 51

narrow-angle, 23

Immersion echogram, 55f, 56f

steroid-induced, 176

Immersion ultrasonography, 50, 50f

Globe perforation, 103

Incomplete cataracts, 12

GP see Gas permeable (GP) contact

Inflammatory reaction, 22–23

lenses

Intracapsular cataract extraction, 90

Group 1 drivers, 23

Intraocular lens (IOL), 85, see also Toric

Group 2 drivers, 23

intraocular lens

H

accommodative, 75–82

aspheric, 83–84, 85f, 86f

Haemorrhage

biometry, 68–70

choroidal, 105

calculations, 33–72, 68

closed suprachoroidal, 173

constants

expulsive choroidal, 105

equations, 68t

intraorbital, 103

values, 69

retrobulbar, 103

decentration, 160, 161f

suprachoroidal, 174f

design, 34

Haigis formula, 70

dioptric power, 34

Hallerman-Streiff syndrome, 185

efficacy, 74

Healon, 97–98

foldable, 92–93, 102, 102f

Herpes simplex, 194

haptic prolapse, 161

Herpetic disease, 138

multifocal, 75–82

Hoffer Q, 70

styles, 81

Holladay 1, 70

natural, 87f

Holladay 2, 70

post-operative assessment, 130

Hospital assessment

power equations, 68–70

preoperative, 24

recent technological advances,

medication, 26

73–88

Intraocular lens (IOL) (Cont’d)

Lens echogram

236

secondary, 203

posterior, 64f

spectacle independence, 83, 83f

Light sensitivity, 131

Intraocular pressure

Limbal relaxing incisions (LRI), 81,

measuring, 192

115

post-operative spikes, 127, 130

advantages, 117

Intraoperative floppy iris syndrome

contraindications, 117

(IFIS), 26

disadvantages, 117

Intraorbital haemorrhage, 103

LogMar visual acuity, 28, 28f

IOL see Intraocular lens (IOL)

Loss of vision

IOLMaster, 29, 30f, 42f–44f, 45–46, 59, 65

cortical cataracts, 6

constants, 69

Lowe’s syndrome, 12, 185

equations, 69

LRI see Limbal relaxing incisions (LRI)

practical advice, 45–46, 46f

M

Zeiss, 39–40, 40f, 53

IQ lens, 84–85

Macular oedema, 20–21, 136

Iris

Mature cataracts, 10, 10f

cataract surgery, 160f

Medications

defects, 159

following cataract surgery, 132–133

prolapse, 149

Membrane cataracts, 14

J

Metabolic disorders, 2

Microperforation, 118

Juvenile cataracts, 12–13

Mixed cataracts, 10

K

Modern extracapsular cataract

extraction, 91

Kay Pictures Test, 193f

Modified Fine-Thornton ring, 117

Keratometers, 29, 35–38

Modulation transfer function (MTF), 85

errors in, 36–38

Morgagnian cataracts, 10

improper calibration, 37

MTF see Modulation transfer function

Ketorolac, 136

(MTF)

following cataract surgery, 132–133

Multifocal implantation

L

patient selection, 82

visual results after, 83

Lamellar cataracts, 12, 13f

Multifocal intraocular lens, 75–82

LASIK, 38

styles

Lens

pros and cons, 81

ageing, 1–14

Myopia, 8, 28

oxidation, 36

N

scatter and absorption changes,

36

Narrow-angle glaucoma, 23

with filters, 87

Nasolacrimal blockage, 24

function, 2

Natural intraocular lens, 87f

growth, 3

Near visual acuity, 27, 28

surgical complications related to,

Neurological disease, 22

160–165

New-onset floaters, 138

Nuclear cataracts, 7–9, 13

comprehensive ocular examination,

brightness acuity tester, 7f

191–193

237

yellowing lens nuclei, 8f

etiology of, 184

NuLens, 76–77

family education and social

Number plate test, 23

circumstances, 204

O

genetic consultations, 195

history, 186

Oblate, 84

investigations, 194

Oblique astigmatism, 109

management of, 196–204

OCT see Optical coherence

morphology of, 185

tomography (OCT)

neonates, 188

Ocular conditions, coexisting

observation, 186

predicting cataract surgery

ocular examination, 186–191

outcomes, 19

posterior capsule management, 200

Ocular movement examination, 194f

primary or secondary IOL

Ocular surface examination, 24

implantation, 200

Ocuscan RxP, 69

prognosis of, 196

OMP see Ophthalmic medical

red reflex test, 186–187

practitioners (OMP)

surgery

Only eye patient, 22

complications, 198–199

Ophthalmic medical practitioners

vs. conservative management, 197

(OMP), 221–222

timing, 197

Optical coherence tomography (OCT),

type, 198

170

systemic examination, 192–193

Optical interferometer, 29

visual assessment, 188

Optic nerve disease, 22

visual significance, 196

Optometrists

Pain, 127, 131

post-operative care, 212–213

Pan-retinal laser photocoagulation

training packages for, 212

(PRP), 20

Optometry referral shared-care scheme

Paracetamol, 127

Queen Victoria Hospital, Brighton,

Partial cataracts, 12

215–218

Partial coherence interferometry, 39–40

Orbscan, 113

Patient letter example, 227

P

PCCC see Posterior continuous

curvilinear capsulorrhexis

Paediatric cataracts, 188

(PCCC)

aetiology, diagnosis, and

PCO see Posterior capsular

management, 183–204

opacification (PCO)

amblyopia, 203

PD see Prism dioptre (PD)

anterior polar and nuclear, 185–186

PDR see Proliferative diabetic

aphakia, 200–202

retinopathy (PDR)

clear visual axis, 200

Perfect Capsule, 76

bilateral, 185

Perkins tonometry, 192

clinical diagnosis of, 186–195

Persistent hyperplastic primary

complications of, intraoperative, 198

vitreous (PHPV), 185

Phaco-chop technique, 99, 100f

Posterior subcapsular cataracts (PSC),

238

Phacoemulsification cataract surgery,

9–10, 9f

27f, 92–101

Posterior vitreous detachment (PVD),

bimanual, 101

138, 171

capsulorrhexis, 98

Post-operative care, 127–129, 212–213,

corneal sutures, 96

215–218, 219–221

hydrodissection, 99

Post-operative management

incision site, 95

cataracts, 125–140

instrumentation, 116

Prager shell, 50f, 51

intraocular lens implantation,

Prednisolone acetate

102

following cataract surgery,

laser cataract surgery, 101

132–133

local anaesthesia, 93–94

PRELEX, 30

microincision, 101

Preoperative biometry, 33–72

small incision, 95

Preoperative hospital assessment, 24

viscoelastic, 97

medication, 26

Phenylephrine hydrochloride, 197

Preoperative investigations, 25

Phimosis

Preoperative tests, 27–30

anterior capsule, 165

Presbyopia, 3, 31

Photophobia, 135

Preservative allergy, 178

PHPV see Persistent hyperplastic

Prism dioptre (PD), 188

primary vitreous (PHPV)

Prolate, 84

Physical activities

Proliferative diabetic retinopathy

following cataract surgery, 132

(PDR), 20

PMMA see Poly methyl methacrylate

Prolonged diplopia, 103

(PMMA)

Prolonged strabismus, 103

Polar cataracts, 11

PRP see Pan-retinal laser

Poly methyl methacrylate (PMMA), 77,

photocoagulation (PRP)

92

PSC see Posterior subcapsular

Post-cataract operation report form

cataracts (PSC)

example

Pseudoaccommodative lenses, 77–81

community, 228–230

astigmatism, 77

Posterior capsular opacification (PCO),

Pseudoexfoliation, 19, 19f, 25

162–163, 163f

Ptosis, 177

after paediatric cataract surgery, 199

Pupil

Posterior capsular rupture, 139

post-operative assessment, 130

Posterior cataracts, 188

reflexes, 192

Posterior continuous curvilinear

PVD see Posterior vitreous

capsulorrhexis (PCCC), 121

detachment (PVD)

Posterior lens echogram, 64f

Q

Posterior polar cataracts, 11f, 12

Posterior segment complications,

Quality of life, 18

169–174

Queen Victoria Hospital, Brighton

Posterior staphyloma

shared-care scheme for direct

biometry, 65

optometry, 215–218

Questions asked for accreditation

Service level agreement

assessment, 222–224

for combined direct cataract

239

R

referral, 219–221

Severe glare disability

Redness, 131

cortical cataracts, 7

Red reflex test, 187f

Shared-care scheme

paediatric cataracts, 186–187

for direct optometry referral, 215–218

Refraction, 27

Showering

Refractive changes and stability

following cataract surgery, 132

after cataract surgery, 135

SIA see Surgically induced astigmatism

Refractive complications, 166–168

(SIA)

Refractive error, 35

Silicone contact lenses, 201

Refractive lenses, 79–80

Silicone hydrogel contact lenses, 201

Refractive lens exchange (RLE), 82

Silicone oil, 65

Regional anesthesia

Slit lamp examination, 24, 192

complications of, 103

Snellen acuity, 188

Regression formulae, 68

Snellen measurements, 28

Relative afferent pupillary defect, 24

Sodium hyaluronate (Healon), 97–98

ReStor lenses, 79, 81, 82

Spectacles

energy distribution for, 79f

children, 202

Retained lens matter, 164

free vision for all distances, 108

Retina, 138

Specular microscopy, 27

Retinal disease progression

SRK I and II, 69

coexisting, 174

SRK-T, 70

Retinal tear or detachment, 172

Stellate cataracts, 13

Retinal vascular disorders, 22

Steroids, topical

Retrobulbar haemorrhage, 103

following cataract surgery, 132–133

Retrodots, 11

Strabismus

Return to work

after paediatric cataract surgery, 199

following cataract surgery, 132

Sub-Tenon’s anaesthesia, 93, 94f

ReZoom lens, 81, 82

complications of, 103

Rigid gas permeable (GP) contact

Suprachoroidal haemorrhage, 174f

lenses, 202

Surgically induced astigmatism (SIA),

RLE see Refractive lens exchange (RLE)

110

Royal College of Ophthalmologists

Suture irritation, 148

guidelines, 18, 25, 69, 70t

Sutureless extracapsular cataract

Rubella, 194

extraction (SECCE), 91, 92f

S

Swimming

following cataract surgery, 132

SECCE see Sutureless extracapsular

Syphilis, 194

cataract extraction (SECCE)

Systemic hypertension, 25

Secondary intraocular lens

T

implantation, 201, 203

Second-eye surgery, 135, 136

Target refraction

Seidel test, 129, 129f, 143, 146, 152

biometry, 66–67

Tear film

Urgent cataract surgery, 22

240

inadequate, 37–38

Urine test, 194

Tecnis Z900 lens, 84

User Group for Laser Interference

Telephone assessment, 128

Biometry (ULIB), 69

Theoretical formulae, 68

Uveal complications, 156–159

Titmus Fly test, 191

Uveitis, 19, 136

Tonopen, 192

persistent, 157

Topical anaesthesia, 93

recurrent, 158

Topical antibiotics

V

following cataract surgery, 133

Topical anti-inflammatory agents

Valvular heart disease, 25

following cataract surgery,

VDRL titre, 194

132–133

VEP see Visual evoked potential (VEP)

Topical steroids

Vertical diplopia, 103–104

following cataract surgery,

Vertical prism, 10-D, 190f

132–133

Viscoat, 98

TORCHS tire screen (toxoplasmosis,

Vision

rubella, cytomegalic inclusion

improvement in, 131

disease, herpes simplex, and

loss of

syphilis ), 194

cortical cataracts, 6

Toric intraocular lens, 85–86, 118–122

Visual acuity testing, 193f

advantages and disadvantages,

Visual driving standards, 23–24

122

Visual evoked potential (VEP), 188

astigmatism, 118–122

Visual field examination

combining toric IOL and incision

confrontational, 24

techniques, 122

Vitreo-retinal surgery

biometry, 120

cataract surgery, 136

Centerflex, 119, 119f

Vitreous opacification, 20

C-flex platform, 87

Vitreous wick, 152

ideal, 119

W

post-operative assessment, 122

SN60 single-piece lens, 87

Warfarin, 25–26

Total cataracts, 12, 188

Watering, 131

Toxoplasmosis, 194

Weiss’ ring floating anterior to optic

Traumatic cataracts, 14

disc, 171f

Tropicamide, 197

With-the-rule (WTR), 109, 110f

U

Work

return to following cataract surgery,

ULIB see User Group for Laser

132

Interference Biometry (ULIB)

Wound, 129

Ultrasonography, see also A-scan

complications related to, 143–152

ultrasonography

leak, 143–145

B-scan, 27, 29

after paediatric cataract surgery,

contact, 50f

199

immersion, 50, 50f

WTR see With-the-rule (WTR)

Y

Z

Yttrium aluminum, garnet (YAG) laser,

Zeiss IOLMaster, 39–40, 40f, 53

241

101, 119, 200

Zonular cataracts, 12