We make the diagnosis of cataracts when the human lens has changed in color and texture, such that it is yellow/brown in color and more dense. This combination leads to a decrease in quality of vision. Typically, the symptoms of cataract formation are gradual and the diagnosis is made during an annual eye exam. In other words, the visual decline is typically not sudden.
Forty years ago, the surgeon and patient had to wait until the cataract "ripened". Because cataracts are roughly the size and shape of an M&M candy and were removed in one piece, it was important that they were dense and hard. In those days, the size of the incision to remove the cataract was huge, about six clock hours(180 degrees). Many sutures were placed, and the post op restrictions were numerous. It was in these days that patients stayed overnight in the hospital (often for a week) with sand bags holding their heads to keep the head from moving. It was an arduous process for an elderly patient.
For the past 20 years or so we have been removing cataracts using a process called phakoemulsification, which is essentially an ultrasound which breaks the cataract into many pieces. They are then vacuumed out of the eye. As a result, the surgical incision has been much smaller (about 2.5mm), no sutures placed, and post-op recovery is much quicker with fewer restrictions. You will likely know many people who have had their cataracts removed in this manner and I am sure they were amazed by their speed of progress. Interestingly, since we now "break apart" the cataract, it can be removed at a much younger age, so now the average age of a cataract patient is in the mid 60's.
We are on the verge of another paradigm shift in cataract surgery, and that is the addition of a femtosecond laser to do many of the manual processes that surgeons have been doing the last 20 years. I have been using a femtosecond laser to create the corneal flap during my Lasik procedures since 2003, so this laser is not new to me. It will make a wonderful addition to our cataract procedure, making the removal of cataracts more exact, precise, and improve accuracy of results even further.
I had the pleasure of talking with a good friend of mine last week. Relating to an article published in Ophthalmology Times on May 15, 2011, Houston based Steve Slade, M.D. said, "using visual acuity outcomes after LASIK as a benchmark, we would have to say there is a need to improve the effectiveness of refractive cataract surgery. Based on our outcomes with the image guided femtosecond laser, I believe this advanced technology will allow us to deliver confidently the results our patients are expecting and encourage more surgeons to expand into the realm of refractive cataract surgery." I have considered myself a "refractive cataract surgeon" for many years. This term implies that during cataract surgery, I make every attempt to make the outcome such that the patient is least dependent on eyeglasses when I am finished. Whether it is correcting astigmatism, or implanting an advanced technology intraocular Lens (ATIOL) that has multi-focal potential, the majority of my cataract patients desire to be spectacle independent if possible.
Dr. Slade went on to say that "we can also imagine this no touch technique will have a particular advantage for improving safety in complicated cases." Now who wouldn't want that? We strive every day for advancements in technology that improve visual outcome, as well as the overall safety of the procedure.
I want to thank Dr. Steve Slade for his contribution to this article. I have had the pleasure of teaching side by side with Dr. Slade for close to 20 years. I appreciate his commitment to working towards the best possible outcome in both Laser Vision Correction (Lasik and PRK) and refractive cataract surgery. Our patients are the ultimate beneficiaries.