2009 recognized as banner year in cataract surgery

This has been a year filled with many exciting developments in cataract surgery. The entry of Abbott Laboratories into the ophthalmology arena and the approval of the first femtosecond laser for cataract surgery represent two of the top news stories.

Randall J. Olson, MD, The John A. Moran Presidential Professor and Chairman, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City; Robert H. Osher, MD, professor of ophthalmology, University of Cincinnati, OH, and medical director emeritus, Cincinnati Eye Institute; and Mark Packer, MD, clinical associate professor of ophthalmology, Oregon Health & Science University, Portland, shared their perspectives on some of the most notable developments in cataract surgery in 2009.

Dr. Olson said that the dialogue surrounding this new technology shows a clear division of ophthalmologists into camps of skeptics and enthusiasts. Dr. Olson, Dr. Osher, and Dr. Packer are clearly aligned with the latter.

"One argument against the femtosecond laser is that cataract surgery outcomes are so good that there is no real need for this expensive device," Dr. Packer said. "However, there is such a compelling story about how this technology could make the procedure even more predictably safe and effective."

Dr. Olson said that the femtosecond laser should yield a perfectly sized and centered capsulorhexis, which is critical for the performance of accommodating IOLs. It also can create perfect incisions for cataract surgery and astigmatic correction as well as divide and soften the nucleus, even turning surgery in eyes with a hard cataract into a phacoaspiration procedure.

"The biggest reason endophthalmitis continues to be a problem after cataract surgery is that it is not easy to guarantee a perfectly sealing incision, and the inability to make precise incisions also explains the poor reliability with incisional methods of astigmatic control," Dr. Olson said. "The femtosecond laser takes the surgeon factor out of the equation in these areas and guarantees that any ophthalmologist can achieve excellent results."

Not only will nuclear fractionation and softening with the femtosecond laser afford greater safety by limiting the amount of ultrasound energy used, but it also will decrease the risk of posterior capsule rupture, said Drs. Olson and Osher.

Dr. Osher characterized the femtosecond laser as a truly exciting merger of cataract and refractive surgery.

"This gives surgeons an opportunity to raise the bar in precision, surgical efficiency, and perhaps even safety, and is especially important for its ability to deliver better results in premium IOL cases where there is no tolerance for complications and a good visual outcome depends on exactness in capsulorhexis size and centration," he said.