When it comes to incisions in the eye, it would seem that smaller is better. But is that always the…
The Patient Refuses Refractive Correction!
This 75 year old patient needs cataract surgery because her best corrected vision is 20/50 and it is becoming increasingly…
Draping is an Important Step of Surgery
Though we don’t often show the process of draping for cataract surgery, it is an important step of the procedure.…
The Adherent Posterior Capsule Plaque
This patient had a long-standing cataract with a very dense 4+ posterior sub-capsular component. Pre-operative vision was barely counting fingers…
Removal of a Posterior Capsule Plaque
When we remove the cataractous lens there is sometimes a posterior plaque that is adherent to the capsule. How do…
Technique for using Diamond Keratomes
Diamond keratomes are my favorite instrument for creating the main phaco incisions because they are exquisitely sharp and they make…
Particles in the Vitreous during Cataract Surgery
These small particles appeared in the anterior vitreous during what appeared to be a routine and uncomplicated cataract surgery. The…
Misloaded IOL in a Floppy Iris Cataract Case
Even the best surgical technicians can have a case where the IOL is misloaded into the injector. It is up…
Solution for Incomplete Phaco Chops
You’re an experienced phaco chop surgeon and you come across a case where you just cannot get the chop to…
IOL Power Estimation after Radial Keratotomy
My technician brought the patient to our biometer (Haag-Streit Lenstar) and it simply would not read the corneal power for…
Cataract Surgery Challenges with Prior Radial Keratotomy
This patient had prior RK (Radial Keratotomy) done a few decades ago for the treatment of myopia. The patient was…
Cataract Surgery after 20-cut Radial Keratotomy
We have covered the topic of cataract surgery in eyes with prior radial keratotomy (RK) but this case is unusual…
Some Simple Ophthalmology Mathematics
Ophthalmology has a large degree of math, particularly when it comes to refractive surgery. Our most commonly performed and most…
Surgically Treating Residual Astigmatism
Which do you choose: Limbal Relaxing Incision (LRI) or Laser Vision Correction (LVC) for treatment of residual astigmatism after cataract…
Routine Dense White Cataract Surgery
Finishing up our week of routine cataract cases, today we are reviewing dense white cataracts. In some parts of the…
Routine Phaco Chop Cataract Surgery
Continuing with our series about routine cataract cases, today we present a routine phaco chop surgery. The cataract is chopped…
Routine Flip-and-Chop Cataract Surgery
We have previously featured an instructional video for the Flip-and-Chop method of cataract surgery and there was a very strong…
Routine Toric Case with Surgeon-Loaded IOL
Again, time to learn from a routine case — this is the type of case that is your “bread…
Why I love Routine Cataract Cases
Many of the articles and videos here at CataractCoach.com feature unusual, difficult, or challenging cataract cases. These are fun videos…
What does the patient actually see?
When we examine patients, we are looking at their eyes and their pathologies from the outside seeing in. We can…
Bimanual Dexterity Improves Ocular Surgery
I tell my first-year ophthalmology residents to start doing daily tasks such as eating food, shaving, and brushing teeth with…
Surgical Approach for a Morgagnian Cataract
With a white cataract, typically the cortical layers opacify and may partially liquify, and that can make the surgery more…
Lost Capsulorhexis – here is the Solution
This patient is having cataract surgery but during capsulorhexis creation, the flap edge seems to get lost. And due to…
Cortical Spokes blocking the view for Capsulorhexis
In this cataract surgery, which is otherwise routine, the cortical spokes of the cataract are blocking the view right…
Basics of Limbal Relaxing Incisions (LRIs)
Every incision that is made in the cornea has an effect on its shape and therefore the astigmatism. For a…
Cataract Surgery after Prior Vitrectomy
Cataract surgery in an eye which has undergone a prior pars plana vitrectomy is different in many ways, including lens…
Cataract Surgery Learning Grid
During ophthalmology residency, residents are exposed to cataract surgery in steps, starting from the most basic and ending with advanced…
What I learned about Ophthalmology at age 5
I only remember a few things about kindergarten: playing handball during recess, watching Matilda eat paste, and learning the golden…
Cataract Surgery in Marfan Syndrome
Patients with Marfan Syndrome have a congenital, progressive weakness in the zonular structures which support the crystalline lens. As such,…
Temporal vs Superior Phaco Incisions
[Click link below for full video] Some surgeons prefer to make a superior phaco incision while others prefer a temporal…
Beginning Surgeon Cataract Case Analysis
Becoming proficient at cataract surgery is not easy and the learning curve is quite steep, particularly at the beginning. We…
How to remove stubborn sub-incisional cortex
During cataract surgery it is important that we remove all of the lens cortex in order to minimize post-operative inflammation…
Posterior Capsule Rupture & Anterior Vitrectomy
Early in the learning curve of cataract surgery, beginning surgeons end up with a posterior capsule rupture about 5% of…
Preventing and Treating Capsular Phimosis
The capsular bag contracts when we remove the thick cataract (4+ mm thick) and replace it with a thin IOL…
Comparison of Night Vision with Different IOLs
Patients often ask me if any of the new lens designs will give them youthful vision. The truth is that…
CataractCoach.com celebrates 100 articles/videos!
Thank you to all of our readers for their support over the past three months! We have kept up with…
Should you do a Primary Piggyback IOL?
In highly hyperopic eyes and nanophthalmic eyes the required IOL power can be very high, sometimes in excess of +40…
Cataract Surgery in Small, Hyperopic Eyes
Small eyes make cataract surgery more difficult in many ways: there is less working room in the eye, the IOL…
Salzmann Nodules and Cataract Surgery
Salzmann nodules occur at the limbus or peripheral cornea and can disrupt the ocular surface, even causing an irregular ocular…
Ocular Fixation during Capsulorhexis
Sometimes, even with systemic sedation, patients can have a strong Bell’s reflex under topical anesthesia and that makes it difficult…
Rescuing the Radialized Capsulorhexis
The capsulorhexis is an important early step of cataract surgery because it gives strength to the capsular opening so that…
Quiz: Persistent Corneal Edema – Why?
This 70 year old patient had successful cataract surgery about one month ago. There were no complications. The patient has…
YAG Laser Capsulotomy Techniques
Posterior capsule opacification (PCO) is common after cataract surgery. Even a perfect surgery by a master surgeon still leads to…
Soft Cataract Supra-Capsular Technique
How do you approach a soft cataract, such as a posterior sub-capsular or primarily cortical cataract, with very little nuclear…
Pre-Chopper Technique for Phaco Surgery
The Pre-Chopper instrument was developed by Takayuki Akahoshi MD from Japan and it allows the cataract nucleus to be divided…
Soft-Shell Technique for Viscoelastics
The Soft-Shell Technique for viscoelastic use in cataract surgery was developed by Dr. Steve Arshinoff as a method of getting…
Air Bubbles to Monitor Viscoelastic Retention
Does viscoelastic stay inside the eye when we inject it there to protect the corneal endothelium? Or does it get…
Dispersive vs. Cohesive Viscoelastics (OVDs)
Viscoelastics, also referred to as OVDs (ophthalmic visco-surgical devices), are viscous substances that allow us to make phaco-emulsification easier and…
Nucleus Chop with a 27g Cannula
It is the beginning of the academic year, which in the USA runs from July 1 (start) until June 30…
Efficient Cataract Surgery for Spastic Patient
Rushing during surgery, especially cataract surgery, is a bad decision. It can lead to complications which can cause a poor…
Self-Critical Analysis of Cataract Surgery
For surgeons it is important to be self-critical in oder to continually advance our surgical skills and judgment. The goal…
Flip and Chop early in the Learning Curve
Phaco Chop is my preferred technique of nucleus removal during cataract surgery because it is safe, efficient, and uses much…
Cataract Surgery in Fuchs’ Corneal Dystrophy
Fuchs’ endothelial dystrophy is a disorder in which the corneal endothelium becomes progressively weak, leading to corneal decompensation and decreased…
Phaco Chop with Floppy Iris Syndrome
Many of our male patients take medications to help with urinary flow such as alpha-1 antagonists, the most common of…
Cataract Surgery is always Teamwork
When we watch videos of cataract surgery it seems like a solo act by the surgeon. While the surgeon is…
Basic Principles of Ophthalmic Suturing
I tell my residents that no one is born knowing how to place 10-0 nylon sutures, but rather it is…
Single-Piece Acrylic IOL Injector Loading
All beginning cataract surgeons must know how to load the IOL into the injector for cataract surgery. While this seems…
Slow Motion Analysis of Phaco Chop
When we are watching a cataract surgery video to learn techniques from others, it is often difficult to understand the…
Cataract Surgery with a very shallow Anterior Chamber
This small eye suffered from angle closure and subsequent development of a white cataract. The angle closure was successfully treated…
Cataract Surgery Technique in Highly Myopic Eyes
We have previously featured an article about doing cataract surgery in these highly myopic eyes, so we will focus on the surgical…
Cataract Surgery in Keratoconus
Patients with keratoconus, like all patients, eventually develop cataracts. However, cataract surgery in these keratocomic eyes is not the same…
Slow Motion Analysis of Phaco with EDOF IOL
Among our most popular features is the slow motion analysis of cataract surgery: when we slow down the video, we…
Choosing Refractive Targets to maximize Depth of Field
From this photo it is obvious that the aperture size of a camera makes a large difference in the depth…
Why did we get a Phaco Wound Burn?
The cornea is a very delicate tissue: it’s thin, clear, avascular, and susceptible to damage, particularly from the heat that…
Divide-and-Conquer Technique
To facilitate removal of the cataract nucleus with the phaco probe, it is helpful to divide it into quadrants or…
Recovering from a Hole in the Posterior Capsule
The posterior capsule is very thin (usually about 4μm) and very delicate and in the course of cataract surgery, it…
Stop-and-Chop Technique for Cataract Surgery
The Stop-and-Chop technique for nucleus removal during cataract surgery blends aspects of the Divide-and-Conquer method with some Phaco Chop. Some…
Complex Cataract: multiple challenging issues
This patient had a large rhegmatogenous retinal detachment repaired a few years ago with a successful pars plana vitrectomy. The…
A Sudden Sneeze or Cough during Cataract Surgery
Patients often ask us, “What happens if I have to sneeze or cough during cataract surgery?” And it’s a valid…
Another Corneal Laceration with Traumatic Cataract
Another patient presented to our resident ophthalmology clinic with a 1 day history of doing construction work on a roof…
3 Golden Rules for Patient Discussions
Physicians need to understand importance of patient discussions regarding surgery Letting patients speak, making a specific recommendation, and explaining what…
Why is phaco chop not working here?
This patient certainly needs cataract surgery because the dense nucleus has a large degree of central opacity and that has…
Femto Laser Incisions: Good or Bad?
The femtosecond laser is a powerful tool for ophthalmic surgery. While its use in creating corneal refractive surgery is widely…
Bleeding from Pupil Expander! Now What?
Pupil expansion devices can be helpful to provide sufficient dilation in cataract surgery. This video features guest surgeon Ravi D. Goel,…
What is the secret to a perfect capsulorhexis?
When I examine an eye that had previous cataract surgery years ago, I see two things: the incision and the…
The Curse of the Baby Rhexis
This case is brought to you in conjunction with EyeGuru.org, an excellent resource for both ophthalmologists in training and ophthalmologists…
Corneal Laceration with Ruptured Lens Capsule
At our busy UCLA-affiliated teaching hospital, Olive View-UCLA Medical Center, we frequently get severe ocular trauma including ruptured globes. We…
A Cataract is not always what it seems…
Since we’ve spent so many years studying ophthalmology, the subtleties of our field become second nature to us. We can…
Slow Motion Analysis of Cataract Surgery
There is a lot to be learned from slow-motion analysis and this applies to cataract surgery as well. Think of…
Step-by-Step Technique for Toric IOLs
Toric IOLs can provide the added benefit of addressing astigmatism at the time of cataract surgery. They are available in…
Alignment and Centration of Toric Multi-Focal IOLs
[From CataractCoach.com] New technology has given us the ability to address corneal astigmatism and presbyopia with a toric multi-focal IOL.…
Nevus of Ota Cataract Surgery
Nevus of Ota refers to hyperpigmented lesions on the sclera as well as peri-ocular skin. The color tends to…
3 critical differences in Cataract Surgery for patients over Age 90
Average life expectancy is at an all-time high in the US at 79, with even better news for…
I teach all young surgeons these 3 Tenets for Success
It’s hard to boil down decades of a career into three easy tenets, but the key principles needed for surgical…
The Informed Consent Process for Cataract Surgery
As ophthalmologists, we know the most about cataracts and the potential benefit to our patients of any planned cataract…
Video Review: Posterior Polar Cataract Bowl Technique
This video is from Dr. Ravi Prasad Challa from Hyderabad, India and it shows his bowl technique for performing cataract…
50 Articles / Videos on CataractCoach.com
CataractCoach.com was launched in May and we have kept up with the goal of posting a new teaching article /…
3 tricks for Small Pupil + Flomax Cataract Surgery without Expanders or Iris Hooks
Can you do cataract surgery in an eye with a small pupil without having to use expanders or iris…
If you see VMT on OCT, do not do cataract surgery!
When we do cataract surgery, we remove a relatively thick human, crystalline lens and we replace it with a…
20% of Cataract Patients have an Epi-Retinal Membrane
We must critically evaluate the retina before cataract surgery. When our cataract patients report a decline in vision it is…
The Rule of Nines for Sulcus IOL Power
From CataractCoach.com: With newly developed methods of IOL power calculation, we are approaching 90% or higher accuracy of achieving +/-…
Congratulations new ophthalmology graduates: Are you ready for your first job?
The academic year in the US ends on June 30, which means that every July a new group of about…
Improving Efficiency in the Operating Room
Keep track of all times during your next surgery date to see where you can make improvements. A good surgeon…
3 Rules for Maneuvering Instruments in the Eye
Intra-ocular procedures pose the surgical challenge of working within a very small space with limited room in which to maneuver…
3 Keys for Cataract Surgery in High Myopes
[From CataractCoach.com – see below for full video] Cataract surgery is arguably the most powerful refractive surgery because the new…
3 Steps to Success with Pupilloplasty
3 Steps to Success with Pupilloplasty: (scroll down for video) The iris is a strange tissue — very beautiful but…
4 Crucial Tips for Iris Suturing
The iris is unlike any other tissue in the body. It is beautiful and delicate, but it is also tough…
4 Cases of Surgical Iris Repair
From CataractCoach.com: This young man sustained a terrible trauma which resulted in severe ocular trauma. A shard of glass penetrated…
4 times when you should NOT do surgery
Any surgeon can operate, but it takes a surgeon with good judgment to know when not to operate. During my…
The Biggest Mistake in Ophthalmology that I’ve made in the past 20 years!
From CataractCoach.com: Like you, I love cataract surgery, but there’s more to life than just ophthalmology. Finding Balance in Ophthalmology…
3 Keys to doing 4-point Sceral-sutured IOLs
From CataractCoach.com: With video footage provided by Dr. Michael Patterson, we review the anterior segment approach to 4-point fixation of an IOL…
Surgical Approach to the Dislocated IOL
(scroll down for full video of four-point fixation of an IOL to the sclera) Cataract surgery has an amazing success…
Why did this IOL de-center?
This patient had cataract surgery about 2 months ago with a local ophthalmologist. She did well initially, achieving 20/20 vision…
Is Femto Phaco worth the Cost?
5 years ago, I posed the question, “Is Femto Phaco a case of the Emperor’s New Clothes?” in an article…
What is the critical finding here?
The first year resident correctly identified the white cataract of the right eye, but she missed a critical finding. As…
Plano may not be best refractive outcome for every patient
Some patients may benefit from a small degree of residual hyperopia, myopia or astigmatism. There is a pride that we…
6 Mistakes that Beginning Cataract Surgeons Make
Learning cataract surgery during ophthalmology residency is critically important for many reasons. It is the most widely performed ophthalmic surgery,…
Sneak Preview: 4-point Scleral Sutured IOL
One surgeon cannot be a master of all. Often, teamwork with colleagues can provide the best results for our patients…
Cataract Surgery with Phakic IOL Removal
In one sitting, we can explant the phakic IOL, remove the cataract, and correct the refractive error, including the astigmatism.…
Phaco Incisions can improve or worsen Astigmatism
Astigmatic Effect from Phaco Incision Placement Many patients desire a refractive correction at the same time as cataract surgery.…
3 Rules for making Phaco Incisions
A well-constructed corneal/limbal phaco incision will improve your cataract surgery technique and provide better results for your patient. (scroll down…
Soft PSC: Posterior Sub-Capsular Cataracts Made Easy
Try this technique to increase safety and provide the best visual outcome for your patients with posterior sub-capsular cataracts. (scroll…
Recovering and learning from your surgical complications
Everyone eventually falls off the horse and has a complication. The key is to recover and learn from it, be…
White Cataracts: Can you pass the Quiz?
Only a true cataract expert will pass this 2 minute test! The past five articles and videos have all been…
White Cataract: Solution for the Dense Posterior Nuclear Plate
Looking at this image should intimidate beginning cataract surgeons: this is a whitish-brown totally opaque cataract and it is a…
White Cataract: What is USA Flag Sign? (Hint: Femto)
The USA Flag Sign is seen when we use a femtosecond laser to assist in phaco of a white cataract. (scroll…
White Cataract: Capsulorhexis x 2 in the same eye!
Double-Capsulorhexis Approach to the Intumescent White Cataract (Scroll down for the surigcal video of the Capsulorhexis x 2 Technique) The…
White Cataract: Run-Away Capsulorhexis. Help!
If you’ve done surgery on a patient with a white cataract, you’ve probably experienced the dreaded Argentinian Flag Sign. (Full…
White Cataracts: They are not all the same!
You’ve seen the notation in the patient chart: “DWC” which stands for Dense White Cataract, but there is actually a…
White Cataract Week is Coming Up!
Sneak Preview: tomorrow is the start of White Cataract Week and we will have a new article and new video…
Older Surgical Techniques Still Matter
Yes, I love phaco too, but we should all learn to do SICS as well. (Classic ECCE teaching video below) This…
Cataract Surgery with Pupil Stretching
No need for pupil expansion rings or iris hooks for many cases (full video below) Yesterday’s video about dealing with…
Pseudo-Exfoliation Cataract Surgery
Pseudo-Exfoliation / Small Pupil / Weak Zonules / Shallow AC (watch video below) A sweet 80 year old patient comes…
Artificial Intelligence in IOL Calculations
Evolving IOL Calculations with Artificial Intelligence. (Watch Video Below) An experienced cataract surgeon has developed an intuition after having done…
Cataract Surgery after Radial Keratotomy
This patient was very myopic and desired surgical correction many years before the advent of the excimer laser. As such,…
On-Axis Paired Incisions for Astigmatism
Don’t have a toric IOL? Try this technique to help address astigmatism at the time of cataract surgery.
Heterochromia Iridis Cataract Surgery
Heterochromia iridis is a condition where there are two different iris colors, usually one eye being darker than the other.…
Posterior Polar Cataract: Expert Level with Small Pupil, Floppy Iris, Dense Lens
Yesterday’s video showed the technique of using Visco-Dissection to aid in surgery for posterior polar cataracts. That patient had a…
Successful Posterior Polar Cataract Surgery
Studies have shown that 1 out of 3 posterior polar cataract surgeries result in a ruptured posterior capsule. Here’s the…
Phaco Flip and Chop Technique
The phaco flip technique is when the nucleus is prolapsed out of the capsular bag and then emulsified at the…
Combo Chop: Combining the Advantages of Horizontal and Vertical Phaco Chop
Phaco chop revisited: Combo-chop combines horizontal and vertical chop techniques Combining the advantages of the two techniques can simplify the…
Cataract Surgery and Pterygium Avoidance
(scroll down to see the full narrated surgical video) In most patients who have both a pterygium and a cataract,…
Cataract Surgery with Prior LASIK
With age, everyone who lives long enough will develop a cataract. This means that today’s LASIK patients will someday need…
Cataract Surgery with a Mid-Size Pupil without using iris hooks or expansion devices
How do we do cataract surgery in an eye with a mid-sized pupil of about 3 or 4 mm in…
When the nucleus drops during Cataract Surgery
Every cataract surgeon knows that while complications are rare, if you do a significant volume of surgery, then you’ll certainly…
Approach to the Dense Brunescent Cataract
With Increased Nuclear Density comes Increased Risks Here is how to successfully approach these tough cataract surgery cases: Patients with…