New no-sedation cataract surgery being trialled at Misericordia

Patients receive freezing eye drops, but no sedation

Dr. Stephen Brodovsky performs cataract surgery.
Dr. Stephen Brodovsky performs the no-sedation cataract eye surgery on a patient at the Misericordia Health Centre.

Winnipeg Regional Health Authority
Published Tuesday, October 17, 2017

Lorraine Beck was eagerly awaiting her turn for cataract surgery this morning at the Misericordia Health Centre when she started to explain how the affliction had affected her daily life.

“I’ve had horrible vision since birth,” she said. “For the last two years, my ability to focus on things went away. I was finding it hard to drive, hard to see things after dusk.” 

Beck’s story is not uncommon. Thousands of patients come to the Misericordia Health Centre (MHC) every year for cataract surgery.

But this one would be different. Unlike regular cataract surgeries, this one would be performed without sedating the patient.

The “no-sedation” procedure has been performed as part of a pilot-project at Misericordia since August.

According to Dr. Mathen Mathen, Head of Ophthalmology for the Winnipeg Regional Health Authority, the new technique allows Misericordia to save time and money and reinvest those savings into doing more cataract surgeries.

“No-sedation is a new alternative to patients with no other medical issues,” said Mathen, adding the biggest change is an anesthetist is not required to sedate the patient. “There is no IV, patients can walk into the operating room and, ultimately, it means a faster recovery time.”

By performing 1,500 no-sedation cataract surgery cases this year, MHC ophthalmology surgeons will add 200 additional cataract surgeries with the savings. Surgeons in Brandon are also using the no-sedation process for cataract patients.

Cataracts without sedation are an extension of the innovative work the MHC team has been doing for years. In 2015, for example, a research study pre-screened cataract patients into two categories: high risk and low risk. The low-risk patients no longer require a pre-operative history and physical with their family physician, saving patients’ time and $1.2 million annually in unnecessary testing and extra doctors’ visits.

No-sedation patients are the lowest surgical risk in the low-risk group, said Mathen.

For her part, Beck was happy to be part of the pilot project, one of about 10 patients who underwent no-sedation cataract surgery on this day.

Today’s procedure involved her left eye; she had undergone cataract surgery for the right eye earlier in the month.

“The first surgery (performed by Dr. Stephen Brodovsky) went so well,” she said. “My vision was so improved that my right eye was almost perfect. I could see things clearly at a distance,” she said.

For the procedure, Beck was prepped with eye drops which dilated her left eye. The nurses walked her into the operating room and helped her onto the bed and draped her face and body. Brodovsky then administered the freezing drops to numb Beck’s eye.

Then Brodovsky went to work, using a microscope to maneuver small tools to make a tiny incision in the side of Beck’s eye. An ultrasound tool was used to break up the cataract, which was then vacuumed out. Finally, he inserted an intraocular lens, unfolded it and got it into place, before closing up the incision. The lens will allow Beck to see at almost 20-20 vision, although she will still need glasses for reading.

Once the operation was done, the nurses helped Beck sit up. She was then able to walk out under her own steam to the recovery area. The whole procedure took just under 10 minutes, shaving at least five minutes off the time it would take to do a surgery with sedation.

While waiting in the recovery area for her ride home, Beck said she could already see with the new lens in her eye, even through the clear eye shield placed on her face.

“It’s going to get better very quickly, once the dilation goes down. It’s already a tremendous improvement,” she said. “I can’t say how comforting it is to have Dr. Brodovsky and his team talk you through the procedure and tell you what they were doing. It was great.”

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