Letters. Cataract surgery
The question posed in John Sandford- Smith’s letter (J Comm Eye Health 2000; 13: 62), which asks if there is still a place for intracapsular cataract surgery, is pertinent but not new. I wrote two similar letters in 1992 (Br J Ophthalmol 1992; 76 : 127-8 and BMJ 1992; 304: 1249) drawing attention to the difficulties to be overcome before changing from intracapsular to extracapsular cataract surgery.
Rural Africa, where I practice, cannot be compared to USA/UK/Europe where those who make policy live and work. There is no YAG laser in Benin for example. What should my patients do when they get opacification of the posterior capsule? If tomorrow a generous donor gave me a YAG laser I would still need to be trained to use it and I would need a reliable supply of electricity and some means of getting the laser serviced and repaired.
What my patients want from me is to regain their vision. What I try to provide is an affordable, accessible and modern eye service that can, in the long term, become sustainable. Surgeons should be encouraged to use whatever techniques gives, in their hands, consistently reliable results for their patients. One of the reasons that so many eye clinics are underused is because patients do not see better after cataract surgery. The surgeons who master one technique and satisfy their patients’ desire for restored clear vision are never short of work.