New techniques for cataract surgery

Just 50 years ago, having cataract surgery meant general anesthesia, a five-day stay in the hospital, a high risk of infection and wearing thick corrective glasses for the rest of your life. That’s not the case today.

Cataract surgery has undergone revolutionary changes since then, especially in the past decade. It’s now an outpatient procedure, taking just 20 minutes, done without stitches, usually with just a topical anesthetic.

Doctors implant the corrective lens within the eye. The modern lens implant actually can improve vision by correcting a patient’s nearsightedness, farsightedness and even astigmatism – blurry vision resulting from an irregularly shaped cornea.

“In the 1990s, there’s been a paradigm shift in cataract surgery,” said Dan Beers, a Mountain View ophthalmologist. “Not only can we get rid of the opacity in the eye, we can get rid of the refractive (visual acuity) problem.”

Cataracts are the leading cause of vision loss in adults 55 and older. Usually a result of aging, a cataract is a clouding of the eye’s natural lens, the part of the eye responsible for focusing light and producing clear, sharp images. Old cells in the lens die and are replaced with new ones, but over time, the old cells begin to block and diffuse light as it passes through the lens.

Cataracts more typically appear in older adults, mostly those over 65. However, they can also occur as a congenital condition in children, or in younger adults due to diabetes, autoimmune conditions or the use of steroids, Beers said.

Cataracts usually come on slowly, they may not occur in both eyes at once, and the symptoms may be vague. A patient may notice they are having trouble reading or driving at night, or they might be bothered by glare from bright lights. Frequently, someone might not be aware of a vision problem until failing the vision test for a driver’s license renewal. The point at which most ophthalmologists usually recommend surgery – and Medicare or other health insurance is willing to pay – is when a patient’s vision reaches 20/50.

The surgical procedure for cataract removal and lens implantation is painless and quickly completed – about 20 minutes. The patient arrives at the surgery center about an hour prior to the procedure. Topical anesthetic is applied to the affected eye. Looking through a magnifying device, the physician uses a small diamond blade to make an incision just one-eighth of an inch long. In a process called phacoemulsification, an ultrasonic instrument uses sound waves to break the cataract into tiny pieces, which are suctioned out, leaving behind the intact portion of the lens capsule. A soft, foldable lens is then inserted through the incision. Once inside, the lens is unfolded and set into place.

The newest type of lens implant used for vision correction after cataract surgery is called the multifocal lens.

“With the multifocal lens, 40 percent of my patients no longer need glasses,” he said. The multifocal lens can also be implanted in patients in their 40s or 50s, who don’t have cataracts, but are seeking an alternative to glasses or laser vision correction. The multifocal lens implant is designed with concentric rings that allow the patient to see near, far and in between, much like variable lens glasses, but without the distortions. “It’s not a perfect scenario for replacing youth, but (it’s) pretty good.”

After cataract surgery, the patient remains for a short period of observation and then can go home to resume normal activities, such as reading, driving and light work, within a day after the procedure. The majority of patients will experience improvement in their vision the day following surgery.


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