Thursday, July 27 2023 10:11

Modern Cataract Surgery: Advancements and Considerations

Written by A.Vijay Mudgil, MD, Mudgil Eye Associates

It's safe, effective and may free you from wearing glasses.

Cataracts — cloudy areas on the lens of your eye — are very common. Over half of Americans 80 or older are affected by them. Although cataracts are undetectable at first, later you may notice your vision is blurry, hazy, less colorful, and you may have trouble reading or be sensitive to light. Your eye doctor can diagnose cataracts with a dilated eye exam and recommend surgery.

The good news is cataract surgery — the most commonly performed operation in the U.S. — has come a long way in recent years, thanks to technological advancements and innovative techniques. Modern cataract surgery offers options to improve vision and reduce the need for glasses. Patients should be aware of their options in cataract surgery, along with the associated risks.

Here are three new options in modern cataract surgery.

1. New Intraocular Lenses (IOLs). Traditionally, cataract surgery involved removing the cloudy lens of the eye and replacing it with a monofocal IOL (an artificial lens), providing fixed focus for one distance, typically improving distance vision. But patients still required glasses for near and intermediate vision, and patients with astigmatism still required glasses for all distances.

New toric and multifocal artificial lenses have revolutionized cataract surgery by addressing these limitations. Toric IOLs correct astigmatism (when the cornea is irregularly shaped, resulting in blurred vision at all distances). The design of these new lenses provides sharper vision and reduces the need for corrective lenses.

Multifocal IOLs offer patients the ability to see at multiple distances. These lenses allow simultaneous focus of both near and distant objects, resulting in the maximum freedom from glasses. Often these patients no longer need glasses for driving, using computers or close reading.

Today, there are also toric multifocal artificial lenses that combine both these benefits.

2. Laser Cataract Surgery. Laser cataract surgery is a groundbreaking technique that enhances precision and safety during cataract surgery and offers several advantages over traditional manual surgery. The laser softens the cataract, allowing gentler and more efficient surgical removal, which may lead to reduced surgical trauma. The laser also allows the surgeon to create highly accurate and reproducible incisions in the eye to reduce astigmatism and improve the position of the artificial lens (IOL).

3. Dropless Cataract Surgery. Dropless cataract surgery is a recent development to reduce or eliminate post-operative eyedrops. Traditionally, patients were prescribed multiple eyedrops after surgery to prevent infection, reduce inflammation and promote healing. The dropless approach involves delivering the necessary medications directly into or around the eye at the end of surgery. This may eliminate the patient’s eyedrop burden afterwards. It’s not suitable for all cases, so discuss the benefits and risks with your surgeon.

Risks of Surgery. Although cataract surgery ranks as one of the safest sugical procedures, there are risks. Although relatively rare, risks include infection, bleeding, swelling, retinal detachment, elevated eye pressure and corneal edema.

Some specific risks associated with advanced cataract surgery options include:

  • Toric IOLs: Slight risk of rotational misalignment, which can affect visual outcomes and require surgical realignment of the lens.
  • Multifocal IOLs: Glare, halos or decreased contrast sensitivity, particularly in low-light conditions, for some patients.
  • Laser cataract surgery: A small risk of complications related to laser use, such as a tear in the lens capsule.

All these risks are mitigated by rigorous training and expertise of the surgeon.

Modern cataract surgery has witnessed significant advancements, offering patients improved vision, safety and reduced dependence on glasses. Toric and multifocal IOLs provide personalized solutions for astigmatism correction and enhanced vision at multiple distances. Laser cataract surgery enables more precise and predictable outcomes, while dropless cataract surgery simplifies care after surgery.

It’s still important for patients to be aware of the risks and limitations associated with these advanced techniques and consult with their surgeon to make informed decisions about their cataract treatment.

A. Vijay Mudgil, MD, founder of Mudgil Eye Associates, has practiced in West Chester for over 20 years. He’s a fellowship-trained ophthalmologist and former assistant professor at the world-renowned Wilmer Ophthalmological Institute at Johns Hopkins Hospital and has been ranked a Top Doctor and #1 ophthalmologist for many years. He enjoys spending his free time with his wife and two Maltipoo dogs.