Innovations In Cataract Surgery

By David M. Benderson, MD

Maryland Eye Associates

. http://marylandeyeassociates.com

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Innovations In Cataract Surgery

Cataract surgery has been around for at least 2,500 years. Modern cataract surgery has been influenced by a steady stream of innovation over the past half century. Two advances in particular propelled cataract surgery into the highly successful, vision restoring procedure it is today phacoemulsification and intraocular lens implantation.

In the late 1960s, a New York ophthalmologist, Dr. Charles Kelman, developed phacoemulsification the use of ultrasonic energy to break the lens (cataract) into small pieces to be removed through a small incision. Previously, the entire lens was removed, intact, through a large incision that required a number of sutures to close. Among many improvements, phacoemulsification allowed for faster recovery.

To this day, phacoemulsification remains the gold standard for cataract surgery throughout the developed world.

The second major advance in modern cataract surgery was the development of intraocular lens implants. The first intraocular lens was conceived and successfully implanted by Harold Ridley in London in the late 1940s.

Prior to the use of intraocular lens implants, patients were left “aphakic”, or without a lens, and required very thick “coke-bottle” glasses for vision correction after cataract surgery.

During WWII, Ridley observed that Royal Air Force pilots who ended up with fragments of windshield made of PMMA in their eyes did not develop a severe inflammatory response. Based on this tolerance, Ridley used PMMA to create lenses to be placed within the eye at the time of cataract surgery. Initially, Ridley was widely ridiculed by the medical community. He persisted, and continued to refine his lens implants and technique.

By the 1980s, intraocular lens implantation became widely accepted. Today, intraocular lens implantation is a standard, critical component of nearly all cataract surgeries.

Lens implant technology continues to evolve. We now have lens implants available to correct a wide range of refractive errors, including astigmatism (toric implants) and presbyopia (multifocal implants which correct both near and distance vision).

There are also a number of interesting implants developed over the past several years that have not been approved by the FDA.

One such lens is the Calhoun Light Adjustable Lens (LAL, Calhoun Vision). The LAL is a silicone lens implant that can be treated with a laser following cataract surgery to refine its power. The LAL can be reshaped in a predictable manner by exposure to ultraviolet light providing a minimally invasive technique to refine a patient's vision after surgery.

There are a number of other exciting lens implants in the pipeline. The steady march of innovation will lead to even better options for vision restoration via cataract surgery in the future.