About The Nottingham Cataract Device

The Challenge

Cataract surgery is one of the most commonly performed operations in the world. ‘Capsulorhexis’ or opening of the lens capsule is one of the most crucial and challenging steps performed during cataract surgery. Complications occurring during this stage can make completion of the operation more difficult.

Capsulorhexis is usually performed using a needle or forceps to literally “tear” a circular opening in the anterior lens capsule. This method may produce irregular and variable sized openings in the capsule. Occasionally the edge of the capsular opening may tear in an uncontrolled manner extending around to the posterior surface of the capsule leading to significant complications. Performing capsulorhexis during paediatric cataract surgery is often more difficult due to the elasticity of the lens capsule. Toric lens implantation for the correction of astigmatism requires a very precise size of capsulorhexis to prevent rotation of the lens after implantation. Our device would ensure a predictable size of capsular opening to ensure stability of the toric lens implantation.

This Nottingham University NHS Trust project sponsored by the Wellcome Trust aims to develop a novel, single use, ophthalmic cutting device which creates a uniform, regular and reproducible capsulorhexis. The tool will potentially reduce surgical times and reduce the risk of complications occurring at this stage of the operation.

The Solution

Consultant ophthalmologist Mr John Stokes has developed a novel device to create a circular capsulorhexis which is uniform, centred, continuous and of sufficient strength to withstand the stresses placed upon it during cataract surgery. John has worked with NHS Innovations East Midlands to determine the business potential and the team called upon the development services of product design partners Warwick Design Consultants. The Nottingham Cataract Device project is the subject of a patent application and received a huge financial boost when the project successfully obtained a Wellcome Trust Translational Award of £300,000, the first to be awarded solely to an NHS Trust. This particular project truly reflects the great potential of project collaborations between the NHS, industry and organisations such as the Wellcome Trust.

The Benefits

• Patient and Surgeon Benefit: Improved Accuracy and Success Rate
  Due to the challenge posed by performing the capsulorrhexis in young children, the resultant size of the capsulorrhexis may be highly variable. Complications such as peripheral extension of the radial tear occur more commonly in paediatric surgery. This may result in difficulties implanting an intraocular due to lack of capsular support, necessitating secondary lens implantation at a later date. This project will develop a tool with which to accurately perform cataract surgery in both adults and children, reducing the potential for such errors. Whilst the tool does not “deskill” the procedure, it makes the most complicated and yet most important part of the surgery a great deal easier, improving the success rate, especially in children and reduce the incidence of secondary complications.
• Cost, Affordability and Availability
  Cataracts are the single largest cause of blindness with some 25 million people unnecessarily losing their sight. This figure is increasing by 1.5 million every year with the overwhelming majority who are needlessly suffering from cataract blindness in the developing world. Africa, Asia, China and India account for most cases of cataract blindness with over 1 million children affected in Asia alone. This life crippling, yet curable, condition has a profound effect upon children in the developing world with 50% of children dying within two years of going blind and 90% of those who are blind missing out on school. If such a tool is to make an impact where it is needed most, it needs to be affordable. In addition, the reduction of surgical complications requiring further surgeries and therefore faster recovery time, further cost savings will accrue. The small machined blade is cheap to produce and the completed tool simple to manufacture, sterilise and package. The device will make cataract surgery more accessible as it opens up the number of surgeons who will be able to confidently perform the technique, especially in children. A vast reduction in training time would mean more surgeons available to perform the surgery as the devices removes a level of uncertainty.
• Patient and Surgeon Benefit: Safety
  The retractable blade protects clinicians and patients from accidental sharps injuries during use and disposal. The blade is deployed at the point of cutting, within the eye and retracted before the instrument is removed from the eye.