All About Cataracts

Implantation of a popular multifocal intraocular lens (IOL) during cataract surgery provides clear and stable visual acuity — both for distance vision tasks such as driving and for near vision tasks such as computer work and reading.

Tecnis Multifocal IOL (Image: Abbott Medical Optics)

That’s the finding of a new study published this month in Journal of Cataract & Refractive Surgery.

Researchers in Japan conducted a retrospective study of 72 eyes (of 41 patients) that were implanted with the Array Multifocal IOL (Abbott Medical Optics, Santa Ana, Calif.) after cataract extraction.

The mean age of patients in the study was 48.7 years (range: 18 to 71 years) and all participants were followed for a period of four years after surgery.

Among the results:

• At one month after surgery, mean uncorrected distance visual acuity (VA) was between 20/20 and 20/25, and mean uncorrected near VA was between 20/30 and 20/40.
• Visual acuity remained stable for the four-year study period, but patient satisfaction with near vision decreased at two years after surgery.
• A follow-up laser eye surgery — laser capsulotomy — was performed on 48 eyes (66.7 percent) due to formation of posterior capsular opacification (PCO).

PCO is a clouding of the posterior portion of the lens capsule — the normally clear sac-like structure that holds the eye’s natural lens in place — that is intentionally left in place during cataract removal to prevent certain cataract surgery complications.

Laser capsulotomy is a brief outpatient procedure that uses a special laser (called an Nd:YAG laser) to create a central opening in the lens capsule to restore vision.

The mean time for laser capsulotomy surgery was approximately two years after cataract surgery.

The researchers concluded that the Array Multifocal IOL provided good and stable distance and near visual acuities over the four-year follow-up, despite a significant percentage of eyes receiving the lens implant experiencing posterior capsule opacification that affected near vision and required subsequent surgical treatment.

Ed. note: The Array Multifocal IOL, which was the first FDA-approved multifocal IOL, is no longer available. Abbott Medical Optics has replaced the Array IOL with two new multifocal IOLs: the ReZoom and Tecnis Multifocal IOL. Ask your cataract surgeon for details.

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.

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.

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.