Often, the density of the nucleus and the severity of the cataract relates to the patient’s access to healthcare. In a large city like Los Angeles, we have many different neighborhoods and a very diverse patient population.
At our teaching hospital where I teach cataract surgery to our UCLA residents, dense white cataracts, brunescent cataracts, and complex cases are common and are a weekly occurrence. This makes for a great learning experience for our ophthalmologists in training, plus the patients get a high level of healthcare at low cost or as charity case. These patients are very sweet and are so thankful to regain vision after suffering with counting fingers or worse acuity for many years.
At our private surgery center in Beverly Hills, we also get patients with severe cataracts, but these are relatively rare. The most common cataract type that we see at our center is relatively modest, usually with a pre-op visual acuity of 20/50 to 20/80. These cataracts have less nuclear sclerosis and are relatively soft.
For these Beverly Hills cataracts, using the phaco flip and chop technique is ideal. This method allows us to bring the nucleus away from the posterior capsule and into the iris plane, where it can be chopped into halves. Because of the lower degree of nuclear sclerosis, a modest amount of ultrasonic phaco energy is needed, and these patients will have clear corneas immediately after surgery despite performing phaco outside of the capsular bag. Also remember that we recoat the corneal endothelium with our dispersive viscoelastic prior to inserting the phaco probe into the eye. This technique is also highly efficient, with most routine cases taking just a few minutes. This makes for an easy patient experience and also a quick recovery.
Click below to see phaco flip and chop on a Beverly Hills Cataract: