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The Evolution of Cataract Surgery

By Greg Evans, OD
Diagnostic and technological advances for cataract surgery continue to evolve.

After almost 40 years of practice, I have seen tremendous changes in the evolution of cataract surgery. Prior to the mid 1970s, cataract surgery involved removing both the lens of the eye and the capsule. Implantable lenses had not been perfected leaving patients with very thick, very heavy glasses and poor optics.

The advent of implantable miniature intra-ocular lenses led to a revolution in the industry. Following implantable lenses were folding implantable lenses and single-piece implantable lenses. These lenses could be placed through smaller incisions resulting in faster patient recovery, less risk of complications and less surgically induced complications.

When cataract surgery is performed, the natural lens is replaced with another. That lens is part of an optical system in the eye that focuses light on the retina. The outcome is limited to some extent with how accurately the optics of the eye can be measured so that once in place, the implanted lens is optimally focused on the retina. Thanks to lasers, the accuracy of this procedure has improved dramatically. Lasers perform a host of steps in modern cataract surgery from measuring the optics of the eye (called biometrics), to making incisions (versus a blade), to more accurately opening the lens capsule (a step required to both remove the hazy lens and to insert the new lens), to fragmentation of the lens and finally, to measuring the optics of the eye during surgery.

In addition to the diagnostic and surgical improvements, the actual implantable lens has gone through many developments. Initially, the lenses were a single-focus lens that left the patient uncorrected for astigmatism and presbyopia. Newer designs allow for correction of both of these conditions in the implantable lens. A light-adjustable lens is now in trials, which is implanted like a regular lens, but following implantation, can be externally adjusted to improve the refractive outcomes. The current design uses a photosensitive lens material that is externally adjusted for power after the eye has healed post surgery. Another category of designs being investigated is the multicomponent intra-ocular lens. This is basically a base unit designed to secure the lens implant. The design is intended to allow a safe and easy exchange of the optic component of the lens implant. Which one of these new technologies will prevail remains to be seen.

What I do know is that cataract surgery now compared to the 1970s is a whole new ball game. When I started practicing, it was unthinkable to consider cataract surgery as a refractive, versus medically necessary, procedure. Presently, if a patient is 60 and older or shows any signs of cataract, it’s not uncommon to look at having early cataract surgery, or clear lens extraction, completed instead of Lasik surgery.

Dr. Evans is the founding owner of Evans Eye Care in Palm Desert and can be reached at (760) 674.8806 or online at www.evanseyecare.com.

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