All About Cataracts

Thankfully, congenital cataracts are relatively rare. But when a baby is born with cataracts, prompt treatment is essential to insure normal infant vision development and prevent permanent vision loss from amblyopia.

Performing cataract surgery on an infant poses special challenges to cataract surgeons. Also, an often-debated question is whether the best treatment for the young, developing eyes of an infant after cataract removal is implantation of an intraocular lens (IOL) or the use of contact lenses.

To answer this question, Scott R. Lambert, MD, at Emory University (Atlanta, Ga.) and other members of the multi-center Infant Aphakia Treatment Study Group conducted a study of the two treatment options.

The researchers compared the visual outcomes and adverse events among 114 infants with congenital cataracts who underwent cataract surgery at an average age of 1.8 months. The infants were randomly assigned to either be treated with an IOL (57 infants) or with contact lenses (57 infants).

Results of the study revealed that surgical complications occurred in 28 percent of infants in the IOL group and 11 percent of those in the contact lens group.

At 1 year of age, visual acuity results were equal in the two groups, but more infants in the IOL group (77 percent) experienced adverse events after surgery, compared with 25 percent in the contact lens group.

Infants in the IOL group also were five times more likely to undergo additional eye surgery (63 percent compared with 12 percent in the contact lens group).

“There appears to be no short-term visual benefit and some increased risk to implanting intraocular lenses in infants,” the researchers concluded. But they also said it is “premature to recommend that intraocular lenses not be implanted in infants” and that a longer a follow-up period is needed to clarify the role of IOLs in the treatment of congenital cataracts.

A full report of the study will appear in the July 2010 print issue of Archives of Ophthalmology.

In the past, if you developed cataracts, the only question was when to have cataract surgery.

But today, with recent advances in cataract surgery technology, you can choose among several types of intraocular lenses your cataract surgeon can implant in your eye during the procedure to correct your vision.

In the May 15, 2010 online edition of The Wall Street Journal, Health Journal columnist Melinda Beck outlined the latest intraocular lenses available and the additional cataract surgery cost associated with premium IOLs that reduce your need for bifocals and reading glasses after surgery.

Among the choices noted:

Accommodating IOLs that flex inside the eye in response to focusing effort to restore vision at all distances. Currently, Bausch & Lomb’s Crystalens is the only brand of accommodating IOL that has gained FDA approval for use in the United States. Added cataract surgery cost for a Crystalens IOL: $2,200 to $3,500 per eye.

Multifocal IOLs that have more than one lens power, like bifocal contact lenses. Several brands of multifocal IOLs are available. Added cost for a multifocal IOL: $2,200 to $3,500 per eye.

nanoFLEX IOL. This premium IOL, produced by STAAR Surgical Company (Monrovia, Calif.) is made of a soft biocompatible material called collagen. STAAR’s current nanoFLEX IOL does not yet have FDA approval to be marketed as an accommodating IOL, but cataract surgeons who have used the device say it provides a wider range of vision than conventional IOLs. Currently, the nanoFLEX does not cost significantly more than other monofocal (single-power) IOLs covered by Medicare.

Ms. Beck says that though less than 20 percent of people undergoing cataract surgery today are choosing premium IOLs, that may change as more seniors see the value of paying extra for premium IOLs that reduce their dependence on eyeglasses after surgery.

Bausch & Lomb (Rochester, N.Y.) announced today that it will celebrate the tenth anniversary of its Crystalens accommodating intraocular lens (IOL) this weekend and next week at the annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS) being held in Boston.

Crystalens currently is the only accommodating IOL that has received FDA approval for use in cataract surgery performed in the United States. The lens is designed to restore vision at all distances after cataract removal, including near vision lost to age-related presbyopia.

Broadway, film and television actress Florence Henderson recently had the Crystalens IOL implanted in her eye during cataract surgery and will be at the Bausch & Lomb booth at the ASCRS meeting on Sunday, April 11 at 1 p.m. to discuss her satisfaction with the accommodating IOL.

“I’m very pleased to have experienced such a dramatic improvement in my vision since my Crystalens surgery,” she said in a press release issued today by Bausch & Lomb.

During the Crystalens 10-year anniversary celebration, Bausch & Lomb also will honor 12 cataract surgeons who have implanted more than 1,000 Crystalens accommodating IOLs.

For more information about Crystalens intraocular lenses, visit www.crystalens.com.

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.