Seeing Past the Clouds of Cataracts
by Robert A. Arleo, M.D.
People have suffered from cataracts since the beginning of recorded history.
We know, for example, that the Egyptians tried to restore vision loss from
cataracts by "knocking" the cloudy lens out of the way and into the
back of the eye -- a crude, dangerous solution that generally exacerbated the
Vision has always played an enormously important role in our everyday lives,
so the development of safer, more effective treatment for cataracts has
remained a high priority. Within the past five decades, the advances have been
remarkable. Today patients can expect not only safe surgery to remove the
clouded lens, but they can expect to have excellent vision. Many people see
better than they have in 10 years.
Indeed, the advances in cataract surgery have been relatively swift with the
emergence of biomedical technology and new surgical techniques and
instrumentation. Just thirty years ago, cataract surgery was intracapsular, which involved removing the entire lens and
the capsule that surrounds it. There were no lens implants and the procedure
required many stitches in the eye, creating a surgical astigmatism. Patients
wore an eye patch for several days and relied on "coke bottle" glasses
for the rest of their lives. These thick lenses had to do the work of the lens
that had been removed from the eye.
In the late seventies we learned that it wasn't necessary to remove the
entire lens capsule. By making an incision through the capsule wall, we could
gently squeeze the cloudy lens out and replace it with a new, carefully
measured artificial lens. This still required an incision that was closed with
several stitches. Astigmatism remained a problem and patients required either
glasses or contact lenses. Complete recovery took about six months.
Nevertheless, this was a tremendous advance.
The next step forward in the mid-eighties came with phacoemulsification.
This procedure enabled eye surgeons to shrink the size of the incision to six
millimeters, requiring one or two stitches for closure and reducing surgical
astigmatism. The capsule wall was opened and the lens broken into tiny pieces
using ultrasound. The pieces were vacuumed out of the capsule and the new lens
implanted. Time for vision stabilization and recovery was drastically reduced.
Which brings us to today. Now we have foldable lens
implants, which require an incision so tiny that often no stitches are
required. The carefully measured lens goes into the eye capsule as a tiny roll
of thin plastic. Once in the capsule, it opens up flat and fits snugly into
place. The surgery is safer than ever, recovery is quicker, and vision
immediately following the procedure is excellent. Most patients do not need
corrective lenses for distance, though they may still require reading glasses
as most of us do when we age. For those who do need
additional correction for astigmatism, astigmatic keratotomy or a "toric" intraocular lens, procedures done locally, can
bring them closer to 20-20 vision.
What does the future hold in cataract surgery?
Reasearchers are working on implants that more
closely mimic the natural lens by changing focus, so patients will not need
glasses for any activity. They are also looking into implants that can be
adjusted by using a laser, so the power of the implant can be changed as the
eye changes over time. Incisions are getting smaller and surgical times are
getting shorter, giving patients unparalleled success rates.
Dr. Robert Arleo is board certified in
ophthalmology. He lectures nationally on cataract surgery, and is a clinical
assistant instructor at SUNY Upstate. He is in private practice with Dr. Philip
Lempert at Arleo Eye
Associates and his office is located at 100 Uptown Road in Ithaca. He can be reached at (607) 257-5599.