WHAT’S NEW IN CATARACT SURGERY?
The other day I went in for my annual eye exam. Nothing much had changed from last year. Still, my optometrist told me that I’d be a candidate for cataract surgery in the next few years. I’d heard that it’s quick and painless, but didn’t really know much about it. So I began digging through my usual sources—Harvard & Mayo Clinic—and found that it’s not as simple as I thought. We actually have choices of what kind of artificial lenses we wish installed. The latest is the Tecnis Symfony® extended depth of focus lens.
First, I’ll give excerpts from the March 2016 Harvard Medical School article, What’s the latest in cataract surgery?:
“A cataract—clouding of the lens inside the eye—is a common cause of poor vision and blindness among older adults. But cataracts can be removed and replaced with artificial lenses. ‘Cataract surgery is something that just about everyone will need if you live long enough. Thankfully, with all of the tools and technologies at our disposal, much of it has become fairly routine. The vast majority of people have excellent outcomes with improvement in their quality of vision,’ says Dr. Christian Song, a cataract and refractive surgeon at Harvard-affiliated Massachusetts Eye and Ear Infirmary.
Typical surgery
Cataract surgery is an outpatient procedure. To remove the cataract, the surgeon makes a circular incision around the eye’s lens, and then uses ultrasound technology to break up and remove the cloudy lens. After that, a new lens is slipped into the eye.
Some surgeons still use a scalpel for the incision. But more and more, surgeons are using an ultra-short-pulse (femtosecond) laser. “It allows us to make incisions much more precisely than we can by hand, and softens the cataract for easier removal. I feel it’s also made the surgery a little safer,” says Dr. Song.
Latest trends
Another sophisticated piece of technology that is even newer is called intraoperative wavefront aberrometry. Once the cataract has been removed, a device attached to a microscope measures the total refractive error of the eye. ‘This essentially allows us to more accurately ensure we’re implanting the appropriate lens power for the eye, and increases our chances of hitting our target. This has been especially helpful for people who have had previous laser vision correction, such as LASIK or PRK, where our usual preoperative measurements and calculations are not as accurate,’ says Dr. Song.
The laser and intraoperative wavefront aberrometry have also improved accuracy when eliminating astigmatism (an imperfection in the shape of the cornea or lens that causes images to appear distorted or blurry). During a cataract procedure, the surgeon can correct minor astigmatism by making carefully placed incisions in the cornea to normalize its curvature. For more severe astigmatism, the surgeon can insert special lenses into the eye, called toric intraocular lenses. “This allows a person to see more clearly at a distance with less dependency on glasses, though reading glasses are generally still required for near vision,’ explains Dr. Song.
Actually, all standard replacement lenses require you to use reading glasses after surgery, regardless of whether you have astigmatism. However, you can invest in special multifocal replacement lenses, similar to bifocal eyeglasses that correct both distance and close-up vision.”
Tecnis Symfony Multifocal Lens
Recently, a groundbreaking cataract treatment has become available. Here are excerpts from an article by Dr. David Evans in Better Vision Guide (last modified September 19, 2018) titled Multifocal Symfony Lens for Cataract Patients:
“After a clouded cataract lens is removed, it is replaced with an artificial lens, called an intraocular lens or IOL. [These lenses improve your vision by focusing light on the back of your eye.] In July of 2016, the FDA approved a brand new type of IOL to be used in the treatment of cataracts: the Tecnis Symfony®.
Traditional IOLs are effective, but only correct near or distance vision. (Most people opt for correction of distance vision and use reading glasses to see things up close.) Newer, more advanced multifocal IOLs are able to provide vision correction across multiple distances. This is great for people that don’t want the added hassle of wearing contacts or eyeglasses. But they come with increased complaints of bothersome side effects such as loss in contrast sensitivity, halos, glare and nighttime dysphotopsia.
Proponents believe Symfony IOLs represent a multifocal breakthrough for a couple reasons.
- They don’t have the same issues with loss of contrast, halos, glare and nighttime dysphotopsia that annoy many multifocal IOL patients.
- They boast improved, continuous vision adaptation.
The first reason is important because the new lenses reduce or eliminate the typical side effects normally associated with multifocal IOLs. The second reason is what’s particularly interesting to ophthalmic surgeons and patients considering cataract surgery.
Standard multifocal IOLs cater to distinct focal points for varied distances. They offer correction for near and distance objects, but for all the points in between, they are not quite as adaptable. The Symfony lens boasts no drop off in vision regardless of the distance, meaning that the quality of vision should remain consistent over a wide range of viewing conditions.
Multifocal IOLs are considerably more expensive than traditional IOLs (meaning that the out-of-pocket cost of cataract surgery will go up), and patients often must pay out of pocket for the higher performance lenses. Cataract surgery using traditional lenses is covered by Medicare or insurance and all patients pay are their deductibles, like any other procedure. The additional cost can range from $1,000 to $2,500, depending on the surgeon, location and surgical technology used. The higher cost for the newer technology IOLs is why many people still opt for the traditional technology and simply use reading glasses after the cataracts are removed. But for those who are interested in a multifocal solution after cataract surgery and the potential freedom from all glasses or contact lenses, the Symfony lens could indeed be a game changer.”
Cataract surgery won’t necessarily give you the vision you had when you were much younger. But it’s very likely to improve the vision you have now. “Fortunately,” says Dr. Song, “the great majority of patients are thrilled with their visual results.”