Keeping An Eye On Cataract Surgery

A new way of performing cataract surgery promises to revolutionize this common operation. Here's what you need to know.

By Colette Bouchez 

I remember the first time I suspected my Mom might have  a cataract – a clouding of the lens of the eye that  can begin to appear as early as age 45.   We were in the dry cleaners,  being waited on by a pleasant young woman,  when my Mom decided to pay her a compliment. 

 “You look so lovely in that pink sweater”, she told the young woman, “ it really perks up your complexion.” 

The young woman looked at my mother – not sure she heard right -  and then to me.   I just shrugged my shoulders indicating I wasn’t sure what was going on.  You see the woman wasn’t wearing pink -  her sweater was in fact, bright gold! 

 Indeed, one of the earliest signs of cataracts is  a change in the way colors appear. Since pink and gold are already close on the color wheel,  a vision problem that blocks even a tiny part of that spectrum can turn yellow to pink in a heart beat.  Other symptoms of cataracts include blurry vision, sensitivity to light, and problems with night vision - all of which my Mom was also beginning to experience.

 Ultimately she was diagnosed with cataracts – a problem which affects millions of people every year -  some as young as age 45.   Eventually, she had them removed via what was, at the time, a fairly complicated surgery.

 Today, that same surgery is much faster and easier, thanks to a variety of surgical advances including sophisticated lasers to do all the cutting.  

 Unfortunately, however,  there remains one area of cataract surgery – the releasing of the clouded lens itself from the capsule surrounding it - that still requires manual surgery,  and a precise one at that. In fact, it requires such precision that doctors liken it to cutting a perfect circle freehand - about the third of a size of penny! 

 Now, however, a brand new “marriage” of  precision  laser cutting and 3 D imaging reported today in the  journal  Science Translation Medicine promises to finally update this stage of cataract removal and in the process revolutionize the entire surgical experience – for both patient and doctor!  

 How does it work?

Using a new type of 3D optical “tomography”, doctors can use scattered light streaming from the cornea to form a three dimensional  image of the live tissue of the eye.  This in turn allows the surgeon to clearly and accurately “mark” the boundaries of the clouded lens, ( that tiny circle that needs to be cut)  and with those markings in place, let the laser do cutting – without risk of damaging any of the surrounding eye tissue.
Moreover, by combining this new 3D tomography, with a  femtosecond  laser - (the same kind used in vision correction surgery) the accuracy of cataract removal increases by a dramatic margin.

“"Until this, we had no way to quantify the precision, no way to measure the size and shape of the capsular opening," says Daniel Palanker, PhD, associate professor of ophthalmology at Stamford University who, along with William Culbertson, MD, professor of ophthalmology at the Bascom Palmer Eye Institute at the University of Miami, was a  lead author on the paper. 

 Indeed,  the researchers say the ultra control and precision of the new system allows surgeons to cut circles in the lens capsule that are 12 times more precise.  It also leaves the cut edges twice allowing doctors to create a kind of bio-pocket  into which they can easily slip the new plastic replacement lens.

 "The results were much better in a number of ways — increasing safety, improving precision and reproducibility, and standardizing the procedure," said Palanker.

 He adds that the  new approach also makes the operation  less dependent on the surgical skills of the  doctor, which in turn allows for greater consistency of the procedure overall. For those having the operation, it means more predictable results - no matter who is doing your surgery- as well as a better, tighter fit of the new replacement lens.  This helps reduce the chances of shifting and improves the overall alignment between the new lens and the pupil.  This can be particularly important for those of us who  will later require multi-focal lenses, such as "computer glasses". 

 Currently the system  described in the study has been tested for precision in pig eyes and human eyes from an eye bank with excellent results.  It was also tested for safety on rabbits and in human patients, with a clinical trial of 50 patients yielding  good results. Researchers report an  accuracy and precision rating  10 times that of current cataract procedures. 

Currently the new surgical approach is expected to be available in a large clinical testing situation nationwide in the very near future. 

Although this new approach to cataract surgery is being worked on by a number of medical  laser companies, this particular study was funded by OpticaMedica Corporation of Santa Clara , California, with some of the researchers having a stake in the company and others being employees of the company.

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