By Drs. Barry L. Drucker and Elizabeth Kim
By Drs. Barry L. Drucker and Elizabeth Kim
Just a few short years ago, a polling of American ophthalmologists showed that the majority of cataract surgery done in this country utilized large incisions and rigid intraocular lenses.
At that time the accepted reduction of vision before surgery was considered was in the 20/70 range. In contrast, the present acceptable reduction before one considers surgery is now about 20/40.
Are present day surgeons knife happy?
Why is it acceptable to operate on better seeing eyes today than 10 or 15 years ago? The answer is simply that the results of small incision cataract surgery are so much better than the older large incision type, therefore causing the patients themselves to lower the threshold for needing this fine surgery.
There are four reasons why cataract surgery techniques have improve results to its present heights:
• Smaller incisions that are self healing without stitches
• Correction of pre-existing astigmatism during cataract surgery
• The use of only eye drop anesthesia (topical) and no needles
• Laser technology (IOL Master) to more accurately measure implants
Small incision and self-sealing
We use a diamond self-sealing blade in the clear cornea (no bleeding). The avoidance of vessels obviates the need to stop blood thinners that many of our elderly patients take for health related reasons. The incision is 2.65 mm. (less than 1/8th-inch) wide. This is large enough for a folding intraocular lens to be inserted and requires no suturing. Little if any distortion of the globe results and virtually no astigmatism is induced.
Astigmatism correction at time of cataract surgery
Our active, informed patients want to see well and if possible, without the use of spectacles. We can and often reduce unusual curvature of the cornea by placing tiny incisions with a diamond blade, precisely 600 microns deep (.60 mm) over the exact area of the overly steep cornea. Occasionally “Toric implants” are also used or the combination of both modalities in greater degrees of astigmatism.
Topical eye drop anesthesia
If the patient is not overly nervous, isn’t hearing impaired and communication isn’t a problem, we prefer to avoid potentially dangerous injections around the ocular area and just use numbing drops. After the procedure, immediate vision is restored and no patch is needed. However complicated cases or very advanced cataracts are usually done utilizing injections to totally numb the area around the ocular tissues.
Laser technology to measure implant power
This latest technological advance is more precise to calculate exactly the proper power implant to give the desired surgical result that will allow the patient to see well without the aid of spectacles. Older ultrasound measurements are good, but inherently less accurate. An occasional patient may have a smooth, complication-free surgery, but end up eyeglass-dependent. This is much less likely to occur with the IOL Master. Surgeons and patients want to know, with reasonable certainty, what to expect post operatively. The IOL Master has made cataract surgery more predictable.
In conclusion, the modern cataract surgeon is not knife happy, but is doing a better job.
Dr. Barry Drucker and Dr. Elizabeth Kim are board certified. Dr. Drucker has practiced in Bayside for more than 20 years, is a Fellow of the American College of Surgeons and is a clinical instructor of ophthalmology at the NYU School of Medicine. Dr. Kim has completed a fellowship in Glaucoma at Cornell Medical Center and a fellowship in corneal disease at the Mt. Sinai School of Medicine. They can be reached at 718 224-5500.
