All About Cataracts

The use of a femtosecond laser may bring added precision and safety to modern cataract surgery, according to William W. Culbertson, MD, who spoke at the recent annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS).

Dr. Culbertson is professor of ophthalmology and director of cornea and refractive surgery services at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (Miami, Fla.).

The laser used in laser-assisted cataract surgery is the same type of femtosecond (FS) laser used to create the flap on the surface of the eye during all-laser LASIK surgery. In cataract surgery, it is used to create self-sealing incisions in the cornea, through which the cataract surgeon inserts surgical instruments to remove the cataract and replace the cloudy lens with an intraocular lens (IOL) to restore vision.

The FS laser also can be used to create small, partial-thickness cuts in the cornea (called limbal relaxing incisions) during cataract surgery to correct astigmatism. It also can be used to make a precise opening in the anterior portion of the capsule that surrounds the eye’s natural lens to give the surgeon easy access to the cataract and reduce risks associated with creating this opening with a hand-held surgical tool.

Dr. Culbertson and colleagues recently conducted a study of a proprietary femtosecond laser system (OptiMedica) for cataract surgery in the Dominican Republic. They found that the added precision of the femtosecond laser in creating the opening in the anterior lens capsule may help surgeons more accurately position an IOL in the eye during cataract surgery.

Proper centration of the intraocular lens is essential for optimal visual outcomes, especially when premium aspheric IOLs, multifocal IOLs and accommodating IOLs (Crystalens) are used.

Researchers also are finding the femtosecond laser can be used to segment and soften the cloudy lens, reducing the energy required to break up the cataract with an ultrasonic probe (phacoemulsification) and remove it from the eye with suction, Dr. Culbertson said.

Disclosure:  Dr. Culbertson serves as a consultant to OptiMedica, a medical device company that has developed a femtosecond laser-assisted cataract surgery system. At this time, the OptiMedica system is not FDA approved for use in the United States.

SOURCE:  Benefits of femtosecond laser extend to cataract surgery. Ophthalmology Times. June 15, 2010.

ROCHESTER, N.Y. — The Bausch + Lomb Early Vision Institute and the Lions Clubs International Foundation announced today that the two organizations are forming a new global partnership aimed at conquering pediatric and congenital cataracts, a significant cause of childhood vision loss and blindness.

The Pediatric Cataract Initiative will utilize the resources of both organizations to identify, fund and promote innovative methods of overcoming childhood cataracts for the long-term benefit of children, their families and their communities, according to a press release issued by Bausch + Lomb.

Causes of congenital cataracts include maternal infections during pregnancy such as rubella (also known as German measles). Other causes include metabolic disorders and genetically transmitted syndromes. Causes of pediatric cataracts affecting older children include trauma to the eye.

During its first year, the Pediatric Cataract Initiative’s primary focus will be on the People’s Republic of China, where at least 40,000 children are estimated to suffer from pediatric cataract. The prevalence of pediatric cataract ranges from one to four children per 10,000 births in developing countries – 10 times the rate of occurrence in developed nations.

Surgery to remove a congenital cataract must take place soon very early in life to prevent amblyopia and permanent vision loss. The cloudy lens can be replaced with an intraocular lens during the cataract surgery, or the infant or young child can be prescribed contact lenses to correct his or her eyesight and promote normal vision development.

In less successful cases, access to low vision services may be needed.

For additional information, visit www.PediatricCataract.org.

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.