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.

Laser cataract surgery is fast becoming a reality.

Last month, Houston ophthalmologist Stephen G. Slade, MD, become the first cataract surgeon to perform the laser-assisted cataract extraction procedure in the United States.

Dr. Slade used the LenSx femtosecond laser (LenSx Lasers, Inc., Aliso Viejo, Calif.) for eight cataract surgeries he performed at his office-based surgery center on February 26.

All patients were counseled about cataract surgery risks, and all procedures were successfully completed with the implantation of a premium intraocular lens, according to a press release issued by LenSx on March 9.

“This is the cataract surgery that I would want for my friends, my family and myself,” Dr. Slade said in the release.

In the procedure, the femtosecond laser is used to create self-sealing corneal incisions and to open the capsule enclosing the front surface of the eye’s natural lens (a procedure called an anterior capsulotomy), exposing the cataract for removal. Extraction of the cataract is performed as it currently is in modern phacoemulsification cataract surgery: with an ultrasonic probe that breaks up the cloudy lens for easier removal from the eye.

The use of a femtosecond laser rather than a surgical blade to make the corneal incisions and to perform the anterior capsulotomy transforms cataract surgery into a blade-free procedure, just as femtosecond lasers have similarly transformed LASIK surgery.

Lola Anderson, a Houston resident, was the first U.S. patient to have the procedure performed on her eye. “This was an awesome experience, I didn’t feel a thing,” she said after the surgery.

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.