Cataract 2008: A year in review

December 1, 2008
Cheryl Guttman

Cataract surgery is a modern success story because of the advances in techniques and technology that have been made over the years. Excellent outcomes are becoming routine, and the field only continues to progress, thanks to a steady stream of innovations. Three cataract surgeons share their thoughts on some of the most noteworthy innovations and trends of 2008 and beyond.

Key Points

Past advances in techniques and technology have made cataract surgery a modern success story, with excellent outcomes routinely being achieved. The field, however, remains dynamic and continues to progress, thanks to a steady stream of innovations. The year 2008 is no exception; numerous developments have been made during the year that are enhancing cataract surgery and its results.

I. Howard Fine, MD, clinical professor of ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland; Randall J. Olson, MD, the John A. Moran Presidential Professor and chairman, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City; and Robert H. Osher, MD, professor of ophthalmology, University of Cincinnati, and medical director emeritus, Cincinnati Eye Institute, shared their thoughts on some of the most noteworthy innovations and trends, both recent and forthcoming.

Phaco technology

In Dr. Fine's opinion, some of the newest system highlights include the ability to switch back and forth in the same case from flow- to vacuum-based fluidics, a feature available on two surgical platforms (WhiteStar Signature, Advanced Medical Optics [AMO]; Stellaris Vision Enhancement System, Bausch & Lomb), and the capability to perform 25-gauge sutureless transscleral pars plana vitrectomy with any of the major platforms.

"The latter is a great addition because pars plana vitrectomy is easier and safer than performing vitrectomy from an anterior approach," he said.

The opportunity to perform microcoaxial surgery with different phaco platforms is an area of high interest. In the United States, surgeons can use the integrated phaco platform (Stellaris) to remove lenses with longitudinal ultrasound through a 1.8-mm incision. A microcoaxial phaco system (Infiniti Vision System, Alcon Laboratories), equipped with a proprietary torsional handpiece (OZil), allows surgeons to perform 2.2-mm microcoaxial surgery using torsional ultrasound. Sleeves and phaco needles (MicroSurgical Technology) allow surgeons to perform 2.2-mm microcoaxial phaco using an aforementioned surgical platform (WhiteStar Signature).

"Microincision surgery allows us to achieve astigmatic neutrality and true refractive cataract surgery with an emmetropic outcome," Dr. Osher said. "I think Richard Lindstrom, MD, and I coined that term 25 years ago, but it is an even more relevant goal today, where with the implantation of presbyopia-correcting and toric IOLs, we cannot afford to introduce cylinder into the equation."

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