It's a Whole New Outlook for Cataract Patients

FRIDAY Oct. 3, 2008 -- Cataracts used to be terrible to treat.

Removing them meant stitches in your eye and days spent recuperating. And artificial replacement lenses only came in one power, which meant eyeglasses for most recipients.

But those days are over.

Cataract surgery has been honed to the point where it's now done on an outpatient basis, and people are back seeing in no time at all with vision often much improved over what they had -- even before their lenses clouded up.

"We don't usually have to put a single stitch in the eye," said Dr. Jim Salz, a clinical professor of ophthalmology at the University of Southern California and a spokesman for the American Academy of Ophthalmology. "We make an incision that seals itself. Recovery is much quicker and much more painless."

And many patients aren't only back seeing, they're seeing better than ever, thanks to advances in artificial lenses that more closely mirror normal vision.

"Cataracts are the most common operation performed anywhere in the body in the United States," said Dr. David F. Chang, clinical professor of ophthalmology at the University of California, San Francisco, and chairman of the American Academy of Ophthalmology's Cataract Preferred Practice Pattern Committee. "We're now approaching three million cataract surgeries performed annually, and there have been many improvements in the techniques."

A cataract is a clouding of the eye's lens. Most cataracts are related to growing older, and by age 80, more than half of all Americans either have a cataract or have had cataract surgery, according to the U.S. National Eye Institute.

Some cataracts occur when the proteins that make up much of an eye's lens begin to clump together and start to cloud a small area of the lens. Over time, the cataract can grow larger and cloud more of the lens, affecting vision.

Other cataracts involve the normally clear lens slowly changing to a yellowish or brownish color, which adds a brownish tint to vision.

Researchers don't know exactly why a lens changes with age. One possibility is damage caused by unstable molecules known as free radicals. Smoking and exposure to ultraviolet light are two sources of free radicals. It also could just be general wear and tear on the lens over the years that causes changes in protein fibers, according to eye experts at the Mayo Clinic.

Most cataract surgeries are performed using a procedure known as phacoemulsification. A tiny incision, usually smaller than 3 millimeters, is made on the side of the cornea -- the clear, dome-shaped surface that covers the front of the eye -- and a tiny probe is inserted into the eye. The device emits ultrasound waves that break up the cataract.

"We break the cataract up into small pieces that are sucked out through this tube with very little discomfort to the patient," Salz said. "The surgery can be over anywhere from 10 minutes to 30 minutes. They have very little discomfort, and then they go home. Patients used to be hospitalized for three or four days, with stitches in their eye."

But the truly revolutionary innovation comes into play once the cataract has been removed. Recent breakthroughs have given patients a number of options for replacement lenses that can make their eyesight as good as new.

"In the past, we would take the cataract out, put an implant in, and the patient would have better vision than they'd ever had in their life," Salz said. "But they would still need glasses to read."

That changed about four years ago, when companies began producing artificial lenses that could mimic the eye's ability to see both near and far.

"The multifocal lens is a lens with a special optical design that provides some focus at distance and some focus up close, and therefore reduces the necessity to wear glasses as much," said Chang, who's also chairman of the American Society of Cataract & Refractive Surgery's Cataract Clinical Committee.

"The lens is creating two focal points at any given time," Chang added. "It's like we're here talking, and there's music playing in the background. At any point, you could tune me out and listen to the music, or you could pay so much attention to what I'm saying that you're not aware of the music at all."

Another type of lens is designed to move and flex in response to the eye muscles that control focus. "Unfortunately, it doesn't allow them to focus from the farthest pint to the nearest point, like a young person's lens," Chang said. "But compared to the conventional lens implants, it again provides more range of focus, allowing the patient to wear glasses less."

There remains one significant barrier to access to these new technologies -- cost.

Medicare will cover cataract surgery with standard replacement lenses, but the newer and more revolutionary lens designs are considered luxury items, Salz said. Patients may have to pay $800 to $900 for the additional cost of the lens implant, and another $700 to $1,500 extra to the surgeon, he said.

More information

To learn more about cataracts, visit the American Academy of Ophthalmology.

Posted: October 2008


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