Of all the fields of medicine, cataract surgery has been one of the greatest beneficiaries from advances in techniques and technology. Not so long ago, cataract surgery involved lengthy delays marked by deteriorating vision while the cataract "ripened," an extended and confining recovery period, plus the need for unsightly "cataract" glasses or contact lenses to achieve functional vision after surgery.
Now, the surgery is a simple, out-patient procedure. The stay at an ambulatory surgery center is just a few hours and recovery time after surgery is dramatically reduced. Many people enjoy improved vision with minimal dependence upon corrective eyewear as a result of modern cataract surgery.
The Evolution of Cataract Surgery
A few short years ago, the accepted method of cataract surgery was to open the front portion of the eye and pluck the cataract like a grape. This meant that the cataract had to "mature" or "ripen" to the point that it was firm, making it easier for the surgeon to grasp. For the cataract to reach this stage, vision in the eye became dramatically impaired, often to the point of near blindness.
At first, there were no suitable materials to use as sutures in the eye, so the eye had to be bandaged and heal on its own. This meant the patient was confined to bed with their head literally sandbagged to prevent movement that might jeopardize the healing process. "Cataract" glasses with thick lenses or contact lenses were required to assume the focusing power of the natural lens, which was removed during surgery. Unfortunately, memories of this type of have caused many people to wait needlessly before having cataract surgery.
"No-Stitch" Cataract Surgery Using a Self-Sealing Wound
Although sutures were a major advance, they have been supplanted in most cases by the use of a self-sealing incision. The shape of the incision creates a flap that takes advantage of the natural fluid pressure inside the eye to seal it shut without the need for sutures.
Not every cataract surgery can be performed as a "No-Stitch" procedure. The decision to place a suture is made by the surgeon and always has your best interests in mind.
The advantages of "No-Stitch" cataract surgery using a self-sealing wound include the following:
* Shorter surgery time
* The ability to stop surgery at any point in the procedure
* Dramatically reduced recovery time
* Less surgically-induced astigmatism
* Less discomfort after surgery
To perform "no-stitch" cataract surgery, two other advances were necessary: the development of microsurgical techniques and the creation of foldable artificial lens implants.
Microsurgical Techniques
Cataract surgery is a delicate operation that involves manipulation of the tiny structures of the eye. High-powered microscopes allow the surgeon to view the parts of the eye clearly.
A large incision is no longer required to allow the cataract to be plucked from the eye like a grape. Now, just a tiny incision is necessary so that a probe approximately the width of a match stick can be used to remove the cataract. By use of ultrasound, the probe dissolves the cataract, allowing it to be gently vacuumed from the eye.
Foldable Artificial Lens Implants
Cataract surgery removes the cloudy, natural lens of the eye. Once the natural lens of the eye is gone, another means is needed to bring light rays into proper focus upon the retina. Thick cataract glasses and then contact lenses were used after cataract surgery to perform this function. Unfortunately, both offer a less than satisfactory solution.
Tiny artificial lenses, called intraocular lenses, that could be placed inside the eye proved to be a dramatic solution to clear vision following cataract surgery. They are made of inert materials that do not trigger any rejection responses by the body. Through the use of careful measurements of the eye taken before surgery, your doctor may be able to select a lens power to correct for nearsightedness or farsightedness, helping to reduce dependence upon corrective eye wear after surgery.
A small opening is made in the front of the capsule that holds the natural lens. Cataract Opening
A tiny incision is made to allow for the insertion of a phacoemulsification tip which is used to remove the cataract. By use of ultrasound, the probe dissolves the cataract, allowing it to be gently vacuumed from the eye. Phaco
By using soft material that can be folded, the artificial lens can be inserted inside the eye through the original surgical incision. Insert lens
The lens unfolds to fill the capsule much as the natural lens of the eye had done prior to cataract surgery. Lens unfolds
Illustrations courtesy of Staar Surgical Co., Monrovia, CA
Pain-free Cataract Surgery
Cataract surgery is a pain-free experience thanks to advances in anesthesia. Our patients are awake during the surgery and are able to resume normal activities shortly afterwards. During the relative quick procedure, the surgeon and members of his surgical team attend to your needs. Two types of anesthesia are used to keep our patients comfortable and pain-free during surgery: topical and regional anesthesia.
Topical, or "Eye Drop" Anesthesia - Eye drops are used to anesthetize (numb) the eye allowing patients to have a painless cataract procedure.
Regional Anesthesia - Through the use of an injection gently given near the eye, an anesthetic blocks all feeling in the region of the eye. To eliminate any discomfort during the injection, it is usually given while the patient is momentarily under the effects of a general anesthetic. Regional anesthesia gradually wears off over the course of a day. As it does, the function of the eye is restored.
Each form of anesthetic has its advantages. Your doctor will consider your individual needs to select the form of anesthesia that is best for you. Our goal is to make your cataract surgery a pleasant and pain-free experience.
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