St George’s: a different view

When I first arrived at St George’s Eye Care (SGEC), I already knew that Christchurch and the South Island had so much to offer from great windsurfing (my passion) and surfing to cycling (another passion) tramping and skiing. So when I started to lead the service at SGEC, I wanted to ensure the care we provided also had a great breadth of options for our patients.

I strongly believe each patient should have the option of considering all the latest lens technologies, including premium, toric and multifocal lenses when appropriate. We have modelled the clinic’s workflow to ensure the surgeon and patient can discuss this at the initial assessment and beyond. Similarly, we ensure all our patients are offered a full range of anaesthetic care options including topical, sub-Tenon’s blocks, sedation or general anaesthesia.

Following medical school, house officer placements and time working on an environmental conservation project in Honduras, I undertook eight years of ophthalmology training during which I completed more than 1000 cataract operations with sub-Tenon’s blocks as the standard anaesthesia. It was in 2011, after completing two oculoplastic surgery fellowships, that I started work as a consultant ophthalmologist and began to develop my topical anaesthetic technique. Since then, I have completed more than 3000 topical cataract procedures.

I’m passionate about cataract surgery and love operating and continue to learn and finesse my technique year on year, and I do believe topical anaesthetic surgery confers significant advantages for the patient including less post-operative pain and usually a white eye afterwards, but there are disadvantages. Patients need to be well informed and fully cooperative for the surgery to work well. For example, they must be aware not to move their eye during surgery and to expect some mild pressure feeling. This is reflected in the findings of the Cochrane Library review on sub-Tenon's anaesthesia versus topical anaesthesia in cataract surgery (2015)*. Both are considered acceptable forms of anaesthesia with topical perhaps having slightly more pain during surgery, but slightly less the day after.

I recently surveyed 50 consecutive patients on whom I’d used topical anaesthetic for cataract surgery. What was most satisfying, conducting this survey, was how often the patients would say they had experienced “no pain whatsoever”. Analysis showed 84% reported their pain during surgery as 0 or 1 on a pain scale of 0-10, and the average score for all patients was less than 1.

https://www.cochrane.org/CD006291/ANAESTH_sub-tenons-anaesthesia-versus-topical-anaesthesia-pain-control-and-better-operating-conditions

Dr Paul Baddeley is a consultant ophthalmologist and clinical lead at St George’s Eye Care in Christchurch. He studied clinical sciences at Cambridge University and undertook his medical training at Oxford University, before completing his ophthalmology training in Wales. He has subspecialist training in oculoplastic, lacrimal and orbital surgery and is an experienced surgical training advisor. St. George’s Eye Care opened in September 2015 and now employs two ophthalmologists, Dr Baddeley and Dr Oliver Comyn, a vitreoretinal surgery specialist.

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