SEEING PROGRESS
NEW DEVELOPMENTS IN CATARACT
AND GLAUCOMA SURGERY
AUTHORS Frank Burns, MD and Julie Lee, MD
C
ataract surgery
is the most
c o m m o n
surgical
procedure
performed
in the United
States with over 3
million procedures
performed annually. Recent technological developments in cataract
surgery have enhanced not only the safety of the procedure but have
improved the results that we are able to provide to our patients.
We will discuss these advancements and give you a close look into
how the procedure has evolved into one of the most successful and
life-changing procedures performed today. less astigmatism and better vision. Small incisions also reduce or
eliminate many of the complications associated with larger incisions.
The risk of hemorrhage during cataract surgery is greatly reduced
because most procedures are done through clear corneal incisions.
Coaxial surgery, using a single port for ultrasound, irrigation and
aspiration, allows for the gentle removal of a bulky, cloudy lens
through an incision as small as 2.2 to 2.4 mm. Today, most cataracts
are removed by phacoemulsification, utilizing an ultrasonic probe to
emulsify or break up the cataract into small pieces that are vacuumed
from the eye. Prior to the adoption of this technique, a large incision,
often 12 mm or more, was necessary to remove the lens in one piece
and several sutures were required to close the wounds. Today, acrylic
intraocular lenses are folded and inserted through the small incision.
Once inside the eye, the soft single piece lenses are centered behind
the pupil where they unfold to provide excellent vision.
A cataract is the clouding of the natural lens in our eye. While
there are several causes of cataract formation, such as trauma,
certain medications and even poorly-controlled diabetes, by far the
most common cause is the natural aging process. More than half
of all people have some degree of cataract formation by the age of
60, but surgery is not indicated until the cloudy lens interferes with
essential activities and quality of life. The clouding of the natural lens
usually occurs gradually as the lens proteins denature over time, but
individual patients present differently. Many patients will recognize
that their vision is changing and seek out medical attention early,
while others will not notice the change. Some patients present with
complaints of blurry vision, difficulty seeing road signs or a television
screen, trouble driving at night due to poor vision, or sensitivity to
glare and bright lights. Yet, many patients with cataracts report to
our offices for a routine eye exam, only to discover that their vision
has become so poor that they are no longer able to see to drive safely. Refractive laser technology is a more recent development in
cataract removal. The femtosecond laser is an infrared ultra-short
pulse laser, which can be used to precisely and accurately create the
initial incisions into the cornea and lens. These precise laser incisions
give better centration and fixation of the lens implants. The laser
can also pre-emulsify the lens, reducing the amount of ultrasonic
energy needed to remove the cataract, resulting in a more gentle
removal of the lens. This helps the eye to heal faster, reducing the
amount of swelling and inflammation.
Fortunately, the vast majority of patients undergoing cataract
removal with artificial lens implantation have their vision restored
to a normal level. The 15-minute procedure, typically performed in
an outpatient setting with conscious sedation, has become one of
the safest and most successful procedures performed in the United
States. Over the last three decades, numerous technological advances
have improved the safety and accuracy of the visual outcomes, and
the cataract surgery success rate approaches 98%, as long as the
patient does not have additional eye disease.
A major advancement in cataract surgery was the move to
performing the procedure through a small, self-sealing incision.
Smaller wounds maintain the natural architecture of the eye, creating
Another significant development over the last few years has
been the management of astigmatism during cataract surgery. The
femtosecond laser can correct small amounts of astigmatism by
creating arcuate incisions in the cornea, changing the elongated
football shape of an astigmatic cornea to a spherical or basketball
shape. We also now have astigmatism-correcting intraocular lenses,
called toric lenses, to correct larger amounts of astigmatism. Similar
to toric contact lenses, which have built-in astigmatism correction,
toric intraocular lenses are designed with specific amounts of
correction that can treat varying degrees of astigmatism. Many
patients who have been in glasses or contact lenses most of their
lives are now often able see clearly without glasses following toric
intraocular lens implantation.
Correcting presbyopia is a recent innovation in ophthalmology.
Standard intraocular lenses correct for either distance or near vision,
and spectacles are often necessary for reading after cataract surgery.
Multifocal intraocular lenses provide patients with an extended
range of focusing for distance, intermediate and sometimes near
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JUNE 2019
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