All About Cataracts

Premium intraocular lenses designed to correct astigmatism — called toric IOLs — produce excellent visual outcomes and high patient satisfaction, according to a new study.

Researchers in Canada evaluated the implantation of toric IOLs in subjects undergoing cataract surgery in both eyes. The study included 234 eyes of 117 subjects. In addition to having cataracts, all subjects had from 1.00 to 2.50 diopters (D) of corneal astigmatism prior to surgery.

After cataract removal, all eyes were implanted with an AcrySof Toric IOL made by Alcon (Fort Worth, Texas).

Binocular uncorrected distance visual acuity (UDVA), refractive error, and IOL rotational stability were assessed at 1 day and 1, 3 and 6 months after surgery.

Prior to surgery and at 3 months and 6 months after surgery, patients completed a questionnaire that assessed their dependence on eyeglasses, visual disturbances and satisfaction with their vision using a 10-point scale (1 = completely unsatisfied; 10 = completely satisfied).

Results of the study included:

• Binocular UDVA after surgery was 20/40 or better in 99 percent of patients and 20/20 or better in 63 percent of patients.
• Mean residual refractive astigmatism after surgery was reduced to 0.4 D among all patients.
• IOL alignment was within 5 degrees of the intended position in 91 percent of patients and within 10 degrees of intended in 99 percent of patients.
• 69 percent of patients reported never needing glasses for distance vision after surgery.
• The frequency and severity of halos and glare present prior to surgery were significantly reduced after surgery.
• Satisfaction with vision was rated 7 or higher by 94 percent of patients after surgery.

The researchers concluded that cataract surgery with bilateral implantation of toric IOLs to correct pre-existing astigmatism produced “excellent and stable visual outcomes that patients rated as highly satisfactory.”

A full report of the study is published in the April 2010 issue of Journal of Cataract and Refractive Surgery, the official journal of the American Society of Cataract and Refractive Surgery (ASCRS) and the European Society of Cataract and Refractive Surgeons (ESCRS).

Laser cataract surgery is fast becoming a reality.

Last month, Houston ophthalmologist Stephen G. Slade, MD, become the first cataract surgeon to perform the laser-assisted cataract extraction procedure in the United States.

Dr. Slade used the LenSx femtosecond laser (LenSx Lasers, Inc., Aliso Viejo, Calif.) for eight cataract surgeries he performed at his office-based surgery center on February 26.

All patients were counseled about cataract surgery risks, and all procedures were successfully completed with the implantation of a premium intraocular lens, according to a press release issued by LenSx on March 9.

“This is the cataract surgery that I would want for my friends, my family and myself,” Dr. Slade said in the release.

In the procedure, the femtosecond laser is used to create self-sealing corneal incisions and to open the capsule enclosing the front surface of the eye’s natural lens (a procedure called an anterior capsulotomy), exposing the cataract for removal. Extraction of the cataract is performed as it currently is in modern phacoemulsification cataract surgery: with an ultrasonic probe that breaks up the cloudy lens for easier removal from the eye.

The use of a femtosecond laser rather than a surgical blade to make the corneal incisions and to perform the anterior capsulotomy transforms cataract surgery into a blade-free procedure, just as femtosecond lasers have similarly transformed LASIK surgery.

Lola Anderson, a Houston resident, was the first U.S. patient to have the procedure performed on her eye. “This was an awesome experience, I didn’t feel a thing,” she said after the surgery.

Abbott (Des Plaines, Ill.) announced last week it has received FDA approval for its new one-piece Tecnis Multifocal IOL for cataract patients with and without presbyopia.

Also, the new multifocal IOL has received “presbyopia-correcting IOL” status by the Centers for Medicare and Medicaid Services (CMS), giving Medicare beneficiaries the option to receive the Tecnis Multifocal IOL during cataract surgery for an additional fee to cover the extra cataract surgery cost.

“With this approval, Medicare cataract patients have a new opportunity to enjoy near, intermediate and distance vision without needing glasses,” said Jim Mazzo, senior vice president, Abbott Medical Optics (AMO) in a press release issued by the company on March 10.

According to the company, nearly 9 out of 10 patients undergoing cataract surgery and receiving the one-piece Tecnis Multifocal IOL in clinical trials reported never needing glasses after surgery.

Abbott has begun shipping the new multifocal IOL to cataract surgeons in select markets and plans for full commercial release beginning in April 2010.

More information about the new one-piece Tecnis Multifocal IOL, including important safety information, is available at www.abbottmedicaloptics.com.

Crystalens HD, an accommodating intraocular lens (IOL), is producing excellent visual outcomes and a high degree of independence from eyeglasses after cataract surgery, according to three European eye surgeons.

The surgeons presented their findings at the 2010 winter meeting of the European Society of Cataract and Refractive Surgeons, held in Budapest, Hungary, February 12-14.

Mark Tomalla, MD, of Duisburg, Germany, said he has implanted the Crystalens HD accommodating IOL in a series of 48 patients. At the time of his presentation, 17 of these patients had been been evaluated at a 6-month follow-up visit.

Six months after surgery:

• All patients could see clearly in the distance and at arm’s length without glasses.
• 71 percent reported they did not need reading glasses.
• The remaining 29 percent said they needed reading glasses only occasionally.

Angel Lopez-Castro, MD, reported similar results in his surgical implantation of the Crystalens HD after cataract removal in the eyes of 42 patients in Madrid, Spain. He said 80 percent of these patients achieved uncorrected reading vision of 20/25 or better, and all patients had distance vision of 20/20 or better without glasses.

Kristien Vanhoucke, MD, of Mol, Belgium, reported that 6 months after implanting the Crystalens HD in 26 eyes, 90 percent of these patients reported good vision at all distances and freedom from glasses after cataract surgery.

Crystalens HD is the fourth-generation accommodating IOL produced by Bausch & Lomb (Rochester, NY). The company received approval from the U.S. Food and Drug Administration (FDA) in June 2008 to market Crystalens HD in the United States.

In January 2010, Bausch & Lomb announced the introduction of Crystalens AO, its latest accommodating IOL that is designed to reduce higher-order aberrations for even sharper vision after cataract removal.

All Crystalens accommodating IOLs are premium intraocular lenses and therefore increase cataract surgery cost. Ask your cataract surgeon for details.

SOURCE: Multiple European clinics report promising accommodating IOL visual outcomes. Ocular Surgery News. Published online February 15, 2010.