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.

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.

A toric IOL designed to correct preoperative astigmatism (as well as nearsightedness or farsightedness) in cataract surgery is safe and effective, according to a study published this month in Journal of Cataract and Refractive Surgery.

In the study, an Acri.Comfort 646 TLC toric IOL (Carl Zeiss Meditec AG, Jena, Germany) was implanted in 21 eyes of 12 patients. All patients had visually significant cataracts and moderate to high astigmatism.

All procedures took place at a single surgical center in Alicante, Spain, using a modern micro-incision cataract surgery (MICS) technique.

At 3 months after surgery, follow-up exams found that 91 percent of the patients’ astigmatism was corrected, and mean eyeglass prescription cylinder power decreased from -4.46 diopters (D) before surgery to -0.45 D after surgery.

Uncorrected distance visual acuity after surgery was 20/40 or better in 76.1 percent of eyes, and no complications occurred in any of the procedures.

The mean rotation of the toric IOLs was 1.75 degrees, and lens rotation was 10 degrees or less in all eyes. (Rotation of a toric IOL can cause a loss of best corrected visual acuity and inability to attain 20/20 vision due to induced irregular astigmatism.)

The researchers concluded that implantation of the Acri.Comfort 646 TLC toric IOL during micro-incision cataract surgery is a safe, precise and effective procedure to correct moderate to high astigmatism in cataract patients.

At this time, the Acri.Comfort toric IOL is not FDA-approved for use in the United States.

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.

The investigators conducted a systematic review of several studies that evaluated the effect of surgical removal of cataracts shortly after they were discovered as a measure to improve vision and reduce the risk of injury among older adults. Both published and unpublished studies dating from 1950 to 2008 were included in the research.

Vision data from 737 patients were included in the analysis. Analysis of the data showed that expedited cataract surgery significantly improved visual acuity in most cases. But analysis of pooled data from 535 patients showed only a nonsignificant reduction of falls after cataract surgery.

The researchers concluded that accumulating evidence indicates expedited cataract surgery is effective in significantly enhancing vision but is inconclusive in preventing falls.

The full report of the research appears in this month’s issue of Journal of Cataract and Refractive Surgery.

The results of the study are contrary to research reported in the April 2007 issue of the Canadian Medical Association Journal (CMAJ),* which found evidence that vision and quality of life decrease, and the rate of falls increases, among patients during the waiting period for cataract surgery.

*The consequences of waiting for cataract surgery: a systematic review. CMAJ. Vol 176, No 9. April 24, 2007.

The new IOL, called Crystalens AO, is designed to be free of spherical aberration that affects other IOLs and thereby produce sharper vision after cataract surgery. The announcement follows recent FDA approval of the Crystalens AO for use by cataract surgeons in the United States.

The aspheric optical surfaces of Crystalens AO are designed to improve retinal image quality without compromising depth of field, and therefore the new IOL provides higher quality distance and intermediate vision than other IOLs, according to the company.

“The Crystalens AO has zero spherical aberration, and the combination of the Crystalens platform and AO optics work together to enhance depth of field,” says Andy Corley, president of Bausch & Lomb’s global surgical division in a press release issued today by the company.

The Crystalens AO is the latest addition to the Crystalens line of accommodating IOLs produced by Bausch & Lomb, joining the Crystalens HD and the Crystalens Five-O. Currently, Crystalens is the only brand of accommodating IOL that is FDA-approved for use in cataract surgery performed in the United States.

Unlike conventional IOLs, the optical portion of accommodating IOLs can move slightly within the eye in response to focusing effort, to improve not only distance vision, but intermediate and near vision as well, reducing the need for reading glasses after cataract surgery.

Accommodating IOLs are a premium intraocular lens and therefore will increase your cataract surgery cost.

More information about Crystalens accommodating IOLs is available on Bausch & Lomb’s Crystalens website or by calling the company at 1-877-SEE BETTER.

Advances in cataract surgery technology in 2009 included:

Approval of femtosecond laser technology for cataract surgery

In September, the LenSx laser (LenSx Lasers, Inc., Aliso Viejo, Calif.) became the first femtosecond laser to gain FDA approval for a specific step in the cataract surgery procedure, eliminating the need for a bladed instrument for this step. Proponents say femtosecond laser technology (currently used primarily for LASIK and other laser vision correction procedures) could make a cataract operation even more safe and effective, reducing the risk of certain cataract surgery complications.

New multifocal IOLs

Two new multifocal IOLs were introduced to the U.S. market in 2009: the Tecnis Multifocal IOL (Abbott Medical Optics, Santa Ana, Calif.) and the AcrySof IQ ReSTOR +3.0 D (Alcon Laboratories, Fort Worth, Texas). Both lenses are designed to help patients regain a fuller range of vision after cataract removal and reduce their need for reading glasses. According to preliminary studies, both lenses offer patients a higher degree of freedom from glasses than previous multifocal intraocular lenses.

Investigational IOLs

A number of companies were conducting clinical trials of new premium IOLs not yet approved for use in the United States. These include a “light-adjustable lens” (LAL) being developed by Calhoun Vision (Pasadena, Calif.). The power of this lens can be adjusted by exposing it to a specific wavelength of light 2 to 3 weeks after cataract surgery, depending on the patient’s visual needs.

Another premium IOL under study is an accommodating IOL called the NuLens (NuLens, Ltd., Herzeliya, Israel and Alicante, Spain). Preliminary studies suggest the NuLens can produce significantly greater near focusing power than currently available accommodating IOLs for even greater freedom from reading glasses after surgery.

SOURCE: 2009: A banner year in cataract surgery. Ophthalmology Times. December 15, 2009.

The study evaluated the performance of the AcrySof IQ ReSTOR IOL with +3.0 D add power implanted in both eyes of 93 patients. The procedures took place at five European sites and were performed by five surgeons.

At 6 months after surgery, mean binocular uncorrected visual acuity was better than 20/20 at distance (4 meters), approximate 20/30 at arm’s length and slightly better than 20/20 vision at the patient-preferred reading distance (approximately 16 inches).

In a postoperative survey, the mean patient satisfaction with their vision was 8.3 out of 10, and 88 percent of the patients did not need eyeglasses after surgery.

Researchers in Korea recently conducted a retrospective study of 96 people with glaucoma who underwent phacoemulsification cataract surgery with intraocular lens (IOL) implantation for the treatment of clinically significant cataracts. Forty-eight of the patients had primary open-angle glaucoma (POAG) and 48 had primary angle-closure glaucoma (PACG).

While previous studies have shown that cataract extraction with IOL implantation lowers intraocular pressure (IOP) in patients with and without glaucoma, the focus of this study was to determine which type of glaucoma patients are most likely to achieve the greatest IOP-lowering effect of cataract surgery.

The follow-up period ranged from 24 to 54 months, with a mean of 31 months.

The researchers found that cataract surgery successfully controlled the IOP of 39.6 percent of eyes with POAG and 62.5 percent of eyes with PACG. The criteria of success was attaining an IOP of 21 mm Hg or lower without medical glaucoma treatment or with fewer anti-glaucoma medications than before surgery.

Among eyes with primary open-angle glaucoma, pre-operative factors increasing the likelihood of successful IOP control after cataract surgery were a maximum IOP lower than 31 mm Hg and use of fewer than three anti-glaucoma medications.

Pre-operative factors increasing the likelihood of success among eyes with primary angle-closure glaucoma were a maximum IOP lower than 42 mm Hg, use of fewer than three anti-glaucoma medications and less than 30 percent of the drainage angle of the anterior chamber of the eye being affected by iris adhesions called peripheral anterior synechiae.

The researchers concluded that modern small-incision cataract surgery using phacoemulsification and foldable IOL implantation may help control IOP in some glaucoma patients, reducing or eliminating their need for anti-glaucoma medicine and/or glaucoma surgery.

The study was published in this month’s issue of Canadian Journal of Ophthalmology.