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Trends in Cataract Surgery

US Sensory Disorders Review, 2006:27-9 DOI: http://doi.org/10.17925/USOR.2006.00.00.27
Received: January 12, 2011 Accepted January 12, 2011 Citation US Sensory Disorders Review, 2006:27-9 DOI: http://doi.org/10.17925/USOR.2006.00.00.27

Members of the baby boom generation, born following World War II, are entering their senior years.They are a generation accustomed to technological change and adopting it into their work and personal lives. As they age they are encountering presbyopia and are, we believe, eager to take advantage of surgical options for managing it. At the same time, the ophthalmic industry and ophthalmic surgeons are developing new surgical techniques and products to meet the demands of these patients and their active lifestyles.

Cataract surgery, while mostly confined to those in their 1960s and 1970s, has been the surgical venue in which the basic techniques and products have been developed that will serve as the foundation providing presbyopia artificial lenses.

Cataract Surgery Fundamentals
Cataract removal is generally accomplished through a procedure called phacoemulsification. In this procedure, a probe is inserted through an incision in the cornea, through the dilated pupil, and into the capsule that holds the lens of the eye.The probe, or hand piece, has a rapidly oscillating tip that emulsifies the lens and a tube that aspirates the nuclear material until the lens is completely removed.

Following lens removal, the probe is withdrawn. A syringe-like device with a cartridge holding a folded artificial lens is inserted through the incision and the artificial lens, called an intraocular lens (IOL) is inserted into the capsule where it unfolds. Other instruments are used to position the lens within the capsule. Centering of the typically circular IOL lens is accomplished by ‘haptics’—tiny arms extending from the sides of the lens—that extend to the sides of the capsule.

Until recently, monofocal IOLs were the only lenses available and typically they provided cataract patients with good distance vision, but reading glasses were needed for near vision function. Recent innovations in IOL technology have just begun to offer patients good distance and near vision. This article will review some of those surgical and lens innovations that are setting the stage for a greatly expanded field of ophthalmic surgical practice that aims to give cataract patients—as well as younger, pre-cataract presbyopic patients— greater spectacle independence.

Surgical Innovations
The OZil hand piece recently introduced by Alcon Laboratories is regarded by many American surgeons as a genuine and valued innovation in the design of the phacoemulsification probe and it is gaining wide popularity here. Unlike other instruments, the probe uses oscillating torsional ultrasonic movement of the emulsifying tip rather than longitudinal movement.This has the effect of increasing cutting efficiency, decreasing friction of tip against the cataract-damaged lens which reduces the possibility of an incisional burn. Its chief advantage is that it does not repel nuclear material from the probe tip during the emulsifying process. Surgeons who have adopted this new instrument have been impressed with its increased safety and improved efficiency. On the negative side, the use of the instrument’s angled tip requires a learning curve, which most surgeons can manage in a short time.