Some may wonder why I’ve spent my Labor Day weekend time revising and republishing some former articles on Cataract Surgery here in the Philippines. The answer is simple. A new reader got in touch and explained a very interesting new procedure for curing cataracts via surgery that seemed just too good not to know about. In response to some of my questions, he very generously offered to write us an article about the new procedure, one of his specialties. So without further ado, I present Doctor Miguel Sarabia, an ophthalmologist practicing in Bacolod City, here in the Philippines.
MSICS…Manual Small Incision Cataract Surgery, an Alternative to Phaco.
In the ophthalmology world today, modern cataract surgery is often associated with Phacoemulsification, a high technology procedure using ultrasonic machine to pulverize cataracts thru micro-incisions, after which lens implants are placed inside the eye, most often now with high-tech injector devices.
This type of cataract surgery has been around since the 1990’s and has now evolved into its current state of extremely advanced machines, micro-incisions and amazing multifocal lens implants.
All of these advancements are fabulous for the patient if not for one problem…the price. A state-of-the-art phaco machine now costs about $ 100,000.00 US. This has to be matched with a very good operating microscope costing around the same price. Plus the new machines demand that you use single use cassettes, tubing, and disposable knives, gels etc.
Nowadays, there are also “premium” intraocular lenses, with highly sophisticated optics…and very steep prices….Guess who ends up footing the bill?
Today, in the Philippines, a phaco eye surgery with premium IOL in a class A eye center will set you back at least P 100,000.00 (about $2400 USD at today’s rates) per eye. That’s 200k for both eyes. A lot of money for a retired senior citizen.
So, you may now be asking the question that all my patients ask me….is there a cheaper way to have a good quality eye operation? I asked myself the same question 10 years ago, after I had been doing phacoemulsification of my patients for about 2 years….
Cataract Surgery — MSICS
I did not realize at that time that in order to answer that question I had to personally travel thousands of miles….toINDIA. This is where I witnesses my first Msics surgeries, and that experience has changed my practice of eye surgery forever.
At that time, in year 2000, most of us eye doctors thought that there was no other way to do small incision cataract surgery except thru phacoemulsification. The other alternative was to open the eye at least 2.5 cm, deliver the lens and implant the IOL, after which, it took 5 or six sutures to close the wound. This was my mindset until one day I received a call from my old mentor Dr. Steven Waller , chairman of the USAF department of ophthalmology… he told me that a new system of cataract extraction thru small incision was developed by the doctors of Aravind Eye Hospital, using only manual instruments.
He believed that this was a great technique for doctors practicing in countries where a lot of poor people were blind from cataract. It was very fast, economical and produced almost the same results as patients who underwent phacoemulsification, since it was also a small incision, sutureless technique.
If you watch a video of phacoemulsification and msics, you will note that the initial portion of both operations are essentially the same…an incision into the anterior chamber of the eye . With phaco it is usually a 3mm clear cornea incision. In Msics, it is a 6 mm triplanar incision in the sclera, creating a tunnel into the anterior chamber of the eye. Then, opening of the anterior capsule of the lens with a CCC or continuous curvilinear capsulorhexis…this is a fancy term for a complete circular cut on the anterior capsule of the lens.
Then there is hydrodissection of the nucleus with water, cleaving and separating it from the capsular bag. Both msics and phaco employ this step. The next step is the removal of the nucleus. With phaco, the nucleus is pulverized by the ultrasonic phaco needle, then vacuumed out of the eye.
With MSICS, the nucleus is delivered out of the eye with a spoon-like device…the irrigating vectus. This is actually the only difference between the two techniques.
After the nucleus is removed, both phaco and msics employ irrigation and aspiration devices to clean out the residual cortical material. The last step in both techniques is the same…the implantation of the intraocular lens.
In phaco, foldable lenses are employed because the incision size is only 3 mm in size. In Msics, the lenses used can be rigid lenses because the incision size is usually 5.5 to 6.0 mm which can accommodate a rigid lens.
So what is the difference in performance of foldable lenses vs. rigid lenses? None, actually. They both give good vision to patients.
Many studies now published in the internet comparing the results of Phaco and Msics have the same conclusion…there is no significant difference in the results of both procedures…except… The Cost.
MSICS only costs about P15,000.00 while Phaco would cost around P40-50,000.00.
Cataract Surgery — Is MSICS Any Good?
MSICS in my opinion, is also the safer technique when doing very dense, rock hard or hypermature cataracts. This type of cataracts give problems when using phacoemulsification. Many cases of the cataract falling into the eye have occurred when doing phaco on very hard cataracts. ( just look up “dropped nucleus cataract” in youtube.).
So, now you know the secret of Aravind EyeHospital…Msics. How did I learn Msics? I traveled to Aravind Hospitalin 2001 and trained under the great Dr. Venkatesh, the Msics master of Aravind.
Aravind Hospital is very unique in this world because its primary goal is to provide the best eye surgery to the most number of poor or indigent people inIndia. MSICS is the product of their intensive research to find a cataract technique that could produce similar visual results as PHACO, but at a very much reduced price. So today, about 20,000 cataract surgeries are performed atAravindEyeHospitalsystem…about 80% are MSICS. By the way, the WHO has now recognized Msics as their cataract technique of choice in all U.N. WHO EYE MISSIONS. (www.aravind.org)
By Dr. Miguel Tomas S. Sarabia
Diplomate Philippine Academy of Ophthalmology
Alumni of LAICOAravindEyeHospital,
Community Ophthalmology and MSICS Course.