All About Cataracts

In its December 15 issue, Ophthalmology Times published a “year in review” feature, highlighting key developments in cataract surgery that took place in 2009.

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.

Crystalens HD, the latest generation accommodating IOL produced by Bausch & Lomb, improves vision at all distances compared to the company’s previous model, the Crystalens Five-O, according to a new study.

Speaking at the recent annual meeting of the American Society of Cataract and Refractive Surgery, Jay S. Pepose, MD, PhD, presented the results of a study of 67 eyes implanted with the Crystalens HD intraocular lens during cataract surgery. At one month after surgery, monocular testing of uncorrected visual acuity (UCVA) revealed:

• 79 percent of the eyes were 20/30 or better for distance vision
• 97 percent of the eyes were 20/30 or better for intermediate vision (approximately 32 inches)
• 85 percent of the eyes were 20/30 or better for near vision (approximately 16 inches)

Best-corrected visual acuity (BCVA) with eyeglasses for distance vision was 20/20 or better in 96 percent of eyes and 20/30 or better in 100 percent.

Compared with data from cataract surgery using the earlier Crystalens accommodating IOL, the new Crystalens HD provides better vision at all distances. Forty-two percent of eyes receiving the Crystalens HD IOL attained uncorrected distance vision of 20/20 or better, which is 50 percent higher than the percentage of eyes attaining the same level of UCVA after surgery with the Crystalens Five-O, said Dr. Pepose.

The Crystalens HD also surpassed the UCVA performance of a leading brand of multifocal IOL (AcrySof ReSTOR, Alcon) for distance and intermediate vision:

• 57 percent of eyes with Crystalens HD were 20/25 or better at distance
• 45 percent of eyes with the multifocal IOL were 20/25 or better at distance
• 91 percent of eyes with the Crystalens HD were 20/25 or better at intermediate
• 35 percent of eyes with the multifocal IOL were 20/25 or better at intermediate

The AcrySof ReSTOR multifocal IOL, on the other hand, performed better than the Crystalens HD accommodating IOL when comparing uncorrected near vision. Twice as many eyes receiving the multifocal lens attained 20/20 or better UCVA at near than eyes receiving the Crystalens HD. But the percentage of eyes attaining 20/30 or better UCVA at near was roughly the same for both groups (85 percent).

Accommodating IOLs are single vision intraocular lenses that move slightly in the eye in response to focusing effort to provide a full range of vision. Multifocal IOLs maintain a fixed position within the eye but have an optical portion that contains several lens powers to provide a full range of vision. Both types of IOLs can decrease the need for reading glasses and computer glasses after cataract surgery.

Accommodating IOLs and multifocal IOLs are premium intraocular lenses that cost more than traditional monofocal IOLs used in cataract surgery. Therefore, choosing these lenses will increase your cataract surgery cost. For details, consult a cataract surgeon near you.

Disclosure:  Dr. Pepose, director of Pepose Vision Institute (Chesterfield, MO) and professor of clinical ophthalmology, School of Medicine, Washington University (St. Louis, MO), is a paid a consultant to Bausch & Lomb.

Advances in cataract surgery are occurring every year, making the procedure safer and more effective than ever.

A number of the key advances in cataract surgery took place in 2008. Among the new technology and techniques:

New Phacoemulsification Technology

Phacoemulsification (or “phaco”) is a cataract surgery technique in which the cataract is broken up into small pieces with a small, hand-held probe that has a vibrating tip. The small pieces are then removed from the eye with suction. Phaco is currently the most common technique used for cataract surgery in the United States.

Manufacturers of phaco equipment for cataract surgery introduced several advances in 2008, including probes that allow the procedure to be performed with smaller incisions. This reduces the risk of unwanted astigmatism after cataract surgery. Other advances include new microsurgical tools to help break up very dense cataracts more effectively during phaco cataract surgery.

New Lens Implants

New intraocular lenses (IOLs) introduced or in development in 2008 include presbyopia-correcting IOLs, aspheric IOLs and toric IOLs.

Presbyopia-correcting IOLs

These innovative lenses help restore a person’s ability to see well up close as well as far away, thereby reducing the need for reading glasses and computer glasses after cataract surgery.

The Crystalens HD (Bausch & Lomb) presbyopia-correcting lens that was introduced in 2008 works by having the ability to change position slightly within the eye in response to focusing effort. This type of presbyopia-correcting IOL is also called an “accommodating” IOL. Other brands of accommodating IOLs are currently in development.

Another type of presbyopia-correcting intraocular lens is the multifocal IOL. Multifocal IOLs are similar in design to multifocal contact lenses, containing separate lens powers for seeing distant, intermediate and near objects simultaneously. Examples of multifocal IOLs include The AcrySof ReSTOR IOL (Alcon Laboratories) and the ReZoom Multifocal Lens (Advanced Medical Optics).

Accommodating and multifocal IOLs can be implanted in both eyes, or in one eye only for a “monovision” effect. Some surgeons feel a monovision correction provides better distance vision than having presbyopia-correcting IOLs implanted in both eyes.

Aspheric IOLs

Aspheric IOLs are specially designed to more closely mimic the shape of the eye’s natural lens, which changes in curvature from its center to its periphery. This characteristic of possessing a gradually changing curve is called asphericity (meaning “not spherical,” or “not of the same curve”).

Because they are more similar in shape to the eye’s natural lens, aspheric IOLs are designed to provide sharper vision and reduce higher-order aberrations (HOAs) caused by traditional spherical IOLs. HOAs contribute to glare and reduced contrast sensitivity, especially at night and in other low-light conditions.

Many cataract surgeons appear to believe in the benefits of aspheric IOLs, as the use of thes premium IOLs grew rapidly in 2008.

Examples of aspheric IOLs include the Tecnis IOL (Advanced Medical Optics) and the AcrySof IQ IOL (Alcon Laboratories).

Toric IOLs

Toric IOLs are a new type of premium intraocular lenses that correct astigmatism.

In the past, people who had astigmatism and cataracts had to wear eyeglasses or have an additional surgical procedure to correct their astigmatism after cataract surgery. With toric IOLs, many of these people can see clearly after cataract surgery without the need for full-time glasses or additional surgery.

Use of toric IOLs increased significantly in 2008 and continued future growth is expected. Examples of toric IOLs include the AcrySof Toric IOL (Alcon Laboratories) and the STAAR Toric IOL (STAAR Surgical Co.)

More Advances on the Horizon

As the aging of the U.S. population continues, more and more Americans are having cataract surgery. And more advances in cataract surgery technology are occurring every year, including techniques for smaller incisions and faster recovery time.

To stay up-to-date on the latest news about cataracts and cataract surgery, return to AllAboutCataracts.com often. Or browse AllAboutVision.com’s Cataract Surgeon Directory to find a cataract surgeon near you.