April 2016




New technological advancements in cataract surgery


Rosa Braga-Mele, MD

Rosa Braga-Mele, MD, MEd, FRCSC cataract editor


Over the past few years there has been an abundance of advancements in cataract surgery technologies that have refined the procedure for more efficient surgery and better patient outcomes. In this issue of EyeWorld, we delve into these advancements not only for the cataract surgical procedure itself, but also for diagnostics, combined procedures, drug delivery, and intraocular implant advancements.

When performing cataract surgery today, many more questions arise than just those about removing the nuclear lens and inserting an implant. Patient expectations are higher and demands for refractive cataract outcomes are more intense due to patient education. There are many nuances that one must address prior to or during cataract surgery, such as the issue of correcting corneal astigmatism with either a toric IOL or corneal relaxing incisions. In one feature article, we delve into the world of aberrometry and discuss with Drs. Wolsey, Weinstock, and MacDonald the benefits of more refined preoperative diagnostics as well as intraoperative diagnostics to help guide astigmatism treatments and improve refractive outcomes.

When looking at intraocular lens implants, there are many options, which can sometimes be confusing and overwhelming for both the physician and the patient. Multifocal IOL choices are now more abundant with newer low-add multifocal IOLs that can be advantageous to the right patient or fail to provide the necessary near acuity for others. Drs. Masket, Hamilton, and Lee eloquently outline the importance of patient selection with respect to personality and ocular comorbidities, as well as the importance of setting patient expectations. The article outlines spacing eye surgeries and assessing outcomes and happiness before selecting the IOL for the second eye.

For our combined glaucoma and cataract patients, we now have so many more microinvasive options to help control IOP and minimize the need for pressure-lowering drops. Drs. Ahmed, Lewis, and Vold outline the new MIGS devices and how these may now be standalone procedures for some patients to help control IOP. However, patient selection for optimizing outcomes is key.

The latest technological advancement is femtosecond laser-assisted cataract surgery. But in its current iteration, is it truly better than traditional cataract surgery? Drs. Ramanathan, McLeod, Chiu, and Srikumaran review the procedure and outcomes in another feature article on femto. Perhaps it is more optimized currently to enhance refractive cataract outcomes. But one must keep in mind that patient counseling is essential, and there are significant costs and perhaps a slight increase in OR times.

There have been recent advancements in drug delivery systems for adjuvant care of the cataract surgery patient to help minimize inflammation, pain, and infection both during and after cataract surgery. Drs. Lindstrom, Chang, Liegner, and Lewis delve into the pros and cons of intracameral anti-inflammatory and anti-infective agents versus traditional drop therapy. Dr. Bafna, in turn, introduces us to the idea of a punctal plug drug release device that could turn out to be a very novel way to provide sustained release therapy.

Technological advancements are necessary in medicine to improve outcomes with more efficient and hopefully cost-saving advantages. However, although exciting for both the patient and the doctor, the underlying theme of all the articles seems to be the importance of informed consent, patient counseling, and proper patient selection.

Related articles:

New cataract surgery technology by EyeWorld staff

MIGS and cataract surgery by Michelle Dalton EyeWorld Contributing Writer

Femto in cataract surgery: The state of the technology by Liz Hillman EyeWorld Staff Writer

The evolution of laser cataract surgery by Lauren Lipuma EyeWorld Staff Writer

Cataract surgery in post-refractive surgery patients by Michelle Dalton EyeWorld Contributing Writer

Sound advice for soothing patients during cataract surgery by Maxine Lipner EyeWorld Senior Contributing Writer

New advancements in cataract surgery New advancements in cataract surgery
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