SEEING PROGRESS
(continued from page 23)
without glasses. While these lenses have been available for over
two decades, recent advances in their design have improved their
success rate. While not all patients are glasses-free with multifocal
intraocular lenses, most are less dependent on glasses. Recently,
toric multifocal lenses have been approved by the FDA, allowing
for more refractive intraocular correction than ever before at the
time of cataract surgery. These lenses continue to evolve and newer
models are on the horizon that will likely continue to improve patient
outcomes. To read more about Presbyopia, see page 25.
With these tremendous improvements in intraocular lenses and
cataract removal techniques, the accuracy of vision correction and
outcomes has become a primary focus for the cataract surgeon. New
mathematical formulas and artificial intelligence-based models can
more accurately predict the refractive results, and many cataract
surgeons now achieve accurate refractive correction of greater than
75%. We also have more precise biometers to measure the eye to
within 10 microns, which is critical for accurate intraocular lens
calculations during the preoperative planning process. Many people
are beginning to consider cataract surgery a refractive procedure,
simultaneously reducing the need for glasses while removing the
cloudy lens.
Additionally, many cataract surgeons are employing intraoperative
aberrometry to achieve even more precise vision outcomes. This
technology allows us to measure the entire refractive error of the
eye after the cataract has been removed prior to implantation of the
intraocular lens. This instrument is useful given that measurements
performed on the eye prior to surgery may have small errors that
make intraocular lens selection less accurate. The surgeon is able
to measure the eye while in the operating room, and then select the
intraocular lens power, which may be different from the theoretical
calculations done preoperatively. Recent studies have shown that
the ORA™ intraoperative aberrometer increases the accuracy of
intraocular lens power selection, thus improving the post-operative
outcomes. The ORA™ is particularly useful in patients who have
previously undergone refractive surgery procedures such as RK, PRK
and LASIK, as their pre-operative measurements and intraocular
lens power calculations can be very unpredictable.
Treating glaucoma at the time of cataract surgery is rapidly
becoming a popular and effective surgical option. Minimally
Invasive Glaucoma Surgery, also known as MIGS, is done in
conjunction with cataract surgery. Various microscopic devices
and techniques employed before or after lens removal can help to
lower the intraocular pressure significantly. The most common MIGS
procedure is a titanium stent, the iStent inject®, which is inserted
directly into the trabecular meshwork to improve the drainage of
intraocular fluid from the eye. We are seeing lower post-operative
pressures and better long-term glaucoma control using these MIGS
devices. Although MIGS alone does not cure glaucoma, many
patients are able to reduce or eliminate their topical medications
after cataract surgery combined with MIGS.
It is an exciting time for ophthalmology as the recent technological
advancements in cataract and glaucoma surgery continue to improve
our outcomes, delivering a more satisfying experience for the patient.
24
LOUISVILLE MEDICINE
The femtosecond laser is used to create precise initial incisions in the
lens, called the capsulotomy as shown on the left, and also fragments
the lens, as shown on the right, in order to reduce the amount of ultra-
sonic energy needed to remove the cataract.
The iStent inject® stents create two patent bypass pathways through
the trabecular meshwork in the anterior chamber of the eye which
allows fluid to exit the eye more easily thus reducing the intraocular
pressure in glaucoma patients. It is the smallest medical device known
to be implanted in the human body.
The iStent inject® stents in position following implantation in the
trabecular meshwork.
Our accuracy, precision and results have improved dramatically
with the advent of these numerous technological developments.
Not only do we have fewer complications, but we now have happier,
more satisfied patients with better visual outcomes than ever before.
As ophthalmologists, we are very grateful that we can provide our
patients with one of the most precious gifts, the restoration and
improvement of their vision, thereby improving the quality of
their lives.
Dr. Burns is a private practice ophthalmologist.
Dr. Lee is a private practice ophthalmologist.