In my 20 years as an ophthalmologist, nothing has given me more gratification than the ability to remove a cataract and restore someone’s vision. A cataract is a clouding of the natural lens that occurs with advancing age. Trauma, certain medications, and diseases can also cause cataracts, but like wrinkles, anyone who lives long enough will eventually develop cataracts. Cataracts are so common that surgery to remove them is the most common surgical procedure performed in the United States. Symptoms of cataracts include blurry vision at distance and/or near, difficulty seeing or driving at night, and glare from sunlight or oncoming headlights.
The good news is that cataract surgery has evolved from a very complicated and risky procedure with a prolonged and difficult recovery period to a marvel of modern medicine. Modern cataract surgery is performed in an outpatient setting, with most patients returning to normal activity within a few days.
In the early days, cataracts were removed by “couching”, which involved striking the eye with a blunt object to dislocate the clouded lens into another area inside the eyeball. Through the 1960s and 1970s, the lens was removed in one large piece through an incision in the eye, which meant stitches, long recovery periods, and often, hospitalization. After surgery, since patients could not see without a lens inside their eye, they required thick “coke bottle” type glasses.
Artificial lens implants at the time of surgery became commonplace in the 1980s. They were invented when Sir Harold Ridley, a pioneering British ophthalmologist, discovered that World War II fighter pilots who sustained eye injuries and had pieces of their plastic windshield inside their eyes tolerated the material without infection or inflammation.
These days, cataracts are removed by breaking up the clouded lens with tiny ultrasound equipment and vacuuming out the debris through a tiny 3mm opening. These incisions are so small they rarely require stitches and seal themselves. Instead of “coke bottle” glasses, a foldable lens implant made of acrylic or silicone is inserted through the same tiny 3mm incision and positioned inside the space left by the cataract. This modern procedure results in very rapid recovery and little to no down time from regular daily activities.
In the past few years, the explosion in technology has taken a very safe and successful surgery and made it even better. New vision correcting lens implants have allowed me to correct my patients vision and eliminate the need for distance and reading glasses after surgery. It is very exciting to hear patients describe their experiences with independence from their old glasses after surgery, especially when they were so dependent on glasses beforehand. With the use of astigmatism-correcting and multifocal lens implants, I can correct the vision of almost any cataract patient at the time of surgery. Post-operative day one, when I remove the eye patch in my office, is often the most satisfying day for everyone.
The advances don’t stop with lens implants. Our surgery center was among the first in New Jersey to offer laser-assisted cataract surgery. This new technology automates certain delicate parts of the procedure, softens the cataract making it easier to remove with ultrasound, and makes the incisions with increasing precision. We also have a device that attaches to the operating room microscope called an aberrometer that measures the eye during surgery, improving the selection of the lens power and improving my patients resulting vision.
All in all, it’s an exciting time to be a cataract surgeon. I set the bar very high for my patients and myself. I not only aim to remove the cataract safely and successfully, but to eliminate the need for glasses to the best of my ability.
Despite all the new technology, I still use my skills in the old fashioned technique, when I travel to third world countries. There we don’t have access to modern ultrasounds and microscopes, so I still remove cataracts in one piece. Even with the old-fashioned surgery, I get immense gratification in restoring sight.