In Vivo - CLINICAL CARE

In Vivo

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CLINICAL CARE

New Vision for Cataract Surgery
P&S Physician uses a technique that greatly improves eyesight

Richard Braunstein

The latest advances in cataract surgery – microscopic incisions, along with state-of-the-art lens implants – now mean that people with cataracts can have simpler, less invasive surgery that not only reverses the vision loss caused by the cataract, but improves overall vision and corrects for astigmatism as well. “It’s like laser vision correction for people with cataracts,” says Richard Braunstein, MD, the Miranda Wong Tang Associate Professor of Clinical Ophthalmology.
   Two things have come together within the past two years to make this possible, says Dr. Braunstein. The first is technological advances in the ultrasound technology that’s used to break up the cataract-damaged lens – a procedure called phaco-emulsification. The new, smallest tips now allow cataract surgeons to perform surgery through incisions measuring only 2.2 mm – about the width of a fine necklace chain.
   At the same time, new lenses have become available that fit through these minuscule incisions – and as a bonus, correct for astigmatism. Cataract surgery itself can cause additional astigmatism, by leaving the eye unevenly shaped.
   “Astigmatism happens when you have an eye shaped like a football instead of a basketball,” says Dr. Braunstein. “Larger incisions change the shape of the cornea, weakening it in one direction and not another. By decreasing the size of the incision, we limit the amount of induced astigmatism.”
   While the new micro-incisional approaches cause less astigmatism, the new lenses – called Toric lens implants – can correct for nearsightedness, farsightedness, and astigmatism that the patient may have had before the surgery. First approved by the FDA in 2005 but not widely used until early 2007, after the Centers for Medicare and Medicaid Services clarified coverage issues, the Toric implant is currently the only astigmatism-correcting lens on the market.
   “Our patients think it’s great,” says Dr. Braunstein, who has been offering the new surgical technique, called micro-incisional coaxial surgery, since the summer of 2007. “They see better much more quickly, have less overall risk from the surgery, and have smaller eye wounds that heal more quickly. And since most people have some astigmatism, I think the astigmatism-correcting lens is going to be a real benefit to patients – certainly if they would have needed glasses to correct it otherwise.”
   The Toric lens implant is just one of a number of lens options; by choosing the right lens for the right patient, cataract surgeons can now improve most people’s vision to a remarkable degree, even giving patients both distance and near vision without the need for glasses. “We can’t make guarantees, but in many ways, we can correct much larger degrees of nearsightedness and farsightedness today with cataract surgery than we can with laser vision correction,” Dr. Braunstein says.

—Gina Shaw