Advances in Cataract Surgery

 

The diagnosis of cataract with it’s ensuing visual challenges has led to a progressive step wise improvement in technique, hospitalization (or lack thereof), a brief post operative recovery period and fewer intraoperative and post-operative complications during recovery.

Intracapsular surgery with aphakia and rehabilitation with contact lenses or aspherical high diopter spectacle lenses became obsolete, replaced by extra capsular manual cataract removal, followed by the development of ultrasound phacoemulsification of the crystalline lens.  This technique allowed for the safer implantation of a  pseudophacos in the anatomical space.

Further manual refinement included capsulorrhexix of the anterior capsule, allowing for a consistent placement of the artificial lens inside the vacant lens capsule. 

Clinical experience and patient expectations motivated further refinement of pseudophacos design in materials, haptic design, and multi-focal design.

The addition of refractive surgical  techniques using arcuate corneal incisions, astigmatic pseudophacos further evolved the cataract operation to one where over 80% of patients no longer needed any correction after surgery and could return to work in 24 hours, with some exceptions for laborers or very physically active patients.

The development of YAG laser allowed for a non invasive procedure for the common occurrence of ‘after-cataract:

FEMTO-SECOND LASER for cataract surgery has added another tool, further refining and automating much of the procedure, with the assistance of advanced imaging for precision, replication and repeatability of the procedure.

ALCON , known for it’s ophthalmic products and commitment to cataract removal has developed the “LenSx Laser” platform integrating a robotic system which consist of the microscope, coupling device, femto-second laser, integrated ocular coherence tomography (OCT) combined with a three dimensional imaging system which images the entire anterior segment down to the posterior capsule.

Once the image is obtained and the metrics are computed  the resulting combination allows for corneal entrance incisions, arcuate astigmatic corneal incisions, anterior capsulotomoy, and nuclear quadrantic dissection without surgeon intervention.

The last steps, phacoemulsification and placement of the intra-ocular lens require the use of a phaco-emulsifier, a technique which has been used for about 30 years.

Modern state of the art cataract removal has been facilitated and has been highly effective in improving outcomes, and reducing the cost of this surgery (which is done over 2 million times/year in the United States.

Previously the cost including surgeon’s fees, three days of in patient hospitalization has been reduced from over 4500 per eye to a one hour surgery as an outpatient with a cost of under 1800 dollars to Medicare.

Ophthalmology has had this in place for 30 years !

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