Why Is Modern Day Cataract Surgery So Exciting?

Cataracts, or the normal age-related clouding of the human lens, still remains the most common (curable) cause of blindness in third world countries today. Treating cataracts has been described in the most ancient manuscripts and scriptures of every recorded culture over the last several thousand years. Today, it is commonplace for patients to leave the surgery center and go out to lunch or dinner on the same day as their cataract surgery!

There are five advances which have allowed cataract surgeons and patients to enjoy such great success:

First was the development and widespread use of the operating microscope, which allows a magnified view of the eye throughout the procedure. Prior to this, surgeons used either their naked eye or magnifying glasses.

Second, was the development of microsurgical sutures, which are 1/3 the thickness of a human hair! Though we typically do not use sutures for most cataract procedures today, a decade ago, these small sutures allowed for much more comfortable postoperative healing period.

Third, was the discovery of a jelly substance called viscoelastic. This clear, removable material comes from two unusual sources: the fin of shark and the neck of a rooster! These materials are very well tolerated by the eye, easily removed, transparent, and allows the eye to maintain its round shape during surgery, serving to protect the delicate tissues inside the eye.

Fourth, was the fascinating discovery by an English ophthalmologist, Dr. Harold Ridley, of a lens material which is permanently implanted in the eye and causes no inflammation for the remainder of the patients lifetime. This plastic material, Dr. Ridley noted, was imbedded in the eyes of pilots shot down on their bombing missions in the first world war. The material called polymethyl methacrolate was used to make the bubble window canopy, which the pilots pulled over their heads in their spitfire planes. Dr. Ridley noted that pieces of this material imbedded in the patent’s eye was very well tolerated, and did not cause any type of rejection. Even today, while other materials are still used, polymethyl methacrolate is still the gold standard, now enjoying fifty years of experience, and allows patients to require a very thin prescription for glasses following their cataract procedure. Prior to the routine use of this lens, patients who had no lens replaced in their eye following cataract surgery required the use of very thick glasses, which distorted their vision and cut down significantly on their peripheral (side) field of view.

Lastly, perhaps the most important piece of technical equipment is the ultrasound machine, known as phacoemulsification, which allows the surgeon to sculpt the cataract into small fragments, which are then easily and gently vacuumed from the eye using a very small handpiece. This allows for a much smaller surgical incision, eliminating the need for wound sutures in most cases, and provides a very rapid and comfortable postoperative recovery and visual rehabilitation.

Modern day cataract surgery enjoys the highest degree of safety ever known before. With exquisitely precise instruments used to measure the eye before surgery, we are able to calculate the specific power of the new lens implant, which is gently placed into the eye following removal of the cataract, often allowing patients the freedom of useful vision without glasses for both distance and near activities.

Choose your eye doctor wisely. Many patients already have a comfortable relationship established with an optometrist who can work closely with the surgeon, co-managing the patient’s postoperative care. There is no reason to abandon the special relationship and bond between the patient and his or her optometrist, but instead utilize the services of the surgeon to perform the cataract operation, and then return to the established optometric practice which has provided the level of care and quality that the patient has been accustomed to for many years. If a patient does not have his or her own eye doctor, then postoperative care will certainly be provided by the surgeon and his or her associates. Make sure that your eye doctor is experienced, and adheres to the highest of ethical standards. Commonly, discussing the experiences of others, such as family members or friends, can lead you to finding the doctor /patient relationship which is perfect for you.