All About Cataracts

Modern cataract surgery may have long-term benefits for people with glaucoma and ocular hypertension, according to a new study.

Researchers in Arkansas, Washington and Utah reviewed the medical charts of 266 non-glaucoma patients who underwent phacoemulsification (or “phaco”) cataract surgery to evaluate both short-term and long-term changes in IOP after cataract removal with intraocular lens (IOL) implantation.

Elevated IOP is a risk factor for glaucoma. Lowering IOP may reduce a person’s risk of developing the disease.

All cataract extractions were performed using a technique called “temporal clear corneal phacoemulsification,” in which a small incision is created in the peripheral cornea and an ultrasonic probe is inserted through the opening. This probe breaks the cataract into small pieces so it can be removed more easily.

IOP measurements were taken with a Zeiss Humphrey IOLMaster (Carl Zeiss Meditech), a non-contact automated device, prior to surgery and 1 day, 1 week, 3 months, 6 months, 1 year and 2 years after surgery.

The researcher found that phaco cataract surgery produced both short-term and long-term reductions of IOP, compared with pre-operative measurements. Mean reduction of IOP was:

• 8.2 percent at 3 months
• 4.6 percent at 6 months
• 6.7 percent at 1 year
• 7.8 percent at 2 years

The authors of the study concluded that temporal clear corneal phacoemulsification cataract surgery results in a decrease in intraocular pressure that persists for at least two years following surgery.

SOURCE: Intraocular pressure change after temporal clear corneal phacoemulsification in normal eyes. Acta Ophthalmologica. February 2010.

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.

Persistent use of statin drugs, such as Lipitor and Crestor, may lower your risk of developing cataracts, according to a new study.

In recent years, a growing body of evidence suggests statin drugs, used to lower cholesterol and reduce the risk of heart attack, may have anti-inflammatory effects, and these effects could possibly reduce cataract formation.

Statin drugs are among the most commonly prescribed medications in America. They are designed to lower “bad” cholesterol levels and thereby reduce the risk of heart attack and stroke.

Researchers in Israel conducted a retrospective study that reviewed the medical charts of more than 180,000 new statin drug users from 1998 to 2007 to determine if these individuals developed cataracts or needed cataract removal. During the study period, 27,301 cataracts were diagnosed and 6,976 cataract extractions were performed among the study participants.

Continuous use of statin medications throughout the study period was associated with a significant reduction in the risk of cataracts and cataract surgery among men and women ages 45 to 74 years.  No protective effect was seen in participants who were age 75 or older.

The authors of the study concluded that persistent statin use by adults under age 75 has a protective effect against the development of cataracts.

SOURCE: Persistence with statins and incident cataract: A population-based historical cohort study. Annals of Epidemiology. February 2010.

When a cataract surgery is canceled on the day of surgery, it is stressful for both the patient and the cataract surgeon.

To determine the reasons why cataract surgery gets cancelled at the last moment, researchers in Kuwait performed a retrospective study of 1,952 patients who were scheduled for elective cataract surgery. A total of 234 cases (12 percent) were canceled on the day of surgery.

Primary reasons for short-notice cataract surgery cancellation included:

• Poor control of high blood pressure (32.9 percent)
• Canceled by patient for unspecified reason (19.6 percent)
• Improper control of diabetes (8.5 percent)
• Chest infection or influenza (7.3 percent)
• Eye infection (5.6 percent)
• Heart problems (4.7 percent)
• High eye pressure after local anesthesia (3.4 percent)

The researchers concluded that most cancellations of cataract removal are avoidable, and efforts should be made to reduce the number of canceled and postponed cataract operations.

SOURCE: Why is cataract surgery canceled? A retrospective evaluation. European Journal of Ophthalmology. January-February 2010.