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sexta-feira, 29 de março de 2013

Modern Cataract Treatment----No Suture, No Patch, No Needles

Many advances have been made in cataract surgery over the last 30 years. Many years ago, when a patient had cataract surgery, he or she was placed in the hospital for weeks at a time with sandbags on both sides of the head while the eye healed. The patient was essentially immobilized, and the outcome was often dubious. The artist Monet found this process so distasteful that, after his first cataract surgery, he never returned for the surgery on the second eye. Fortunately, his cataracts had a distinct positive influence on his art, which many of us so much appreciate.

In modern day, almost no cataract surgeries are performed in the hospital. Instead, they are done in outpatient or office-based surgery centers, which are more efficient. The recovery time has been drastically reduced to essentially overnight. With modern techniques of small-incision, clear-cornea, no-suture surgery, patients more often than not see better as they walk out of the office surgery suite.

The majority of patients have driving vision the next day. Also, with the small incision, no blood vessels are encountered or cut through. This is why most patients no longer have red eyes after surgery. In fact, unless you know which eye was operated on, it's often hard to tell. Also for patients on Coumadin, Heparin or other blood thinners like Aspirin, it is no longer necessary to have patients discontinue these medications. This avoids the complications of emboli or thrombus formation seen when patients sometimes discontinue these needed meds.

With an office-based surgery center, it is also possible to have better control over all the variables and focus on one specific treatment such as cataracts. This has allowed for the perfection of topical anesthesia (numbing eye drops) to be utilized for cataract removal rather than having to give an injection with a long needle around or behind the eye to numb the eye, as is still practiced by many cataract surgeons today. In addition to the discomfort to the patient from the needle injection, this also eliminates the complications of perforation of the eye, retinal hemorrhage, bruising (black eyes) and optic nerve atrophy that can accompany the injection.

With the small incisions now used by many modern cataract surgeons, an incision of 3mm or less is made, through which the phacoemulsification probe (also called "laser probe") can be inserted to break up the lens into little pieces with ultrasound and then vacuum them out. With this technique, a foldable lens implant can then be injected in the location of the normal crystalline lens. The implant materials and types have also improved significantly, and the most-popular materials include acrylic and silicon for foldable intraocular lens implants. Lens implants are also available in monofocal implants for distance or near as well as in multifocal implants for both. After injecting the lens implant, it self-seals since the 3 mm incision is so small when constructed properly in a stepwise fashion. This avoids scratching and irritation felt by patients in days past and also avoids additional trips to the surgeon's office to have the sutures removed. This was an unpleasant experience often encountered by patients in days past.

Additionally, since the wound is self-sealing and the eye is not anesthetized with needle injections, it is no longer necessary to patch the eye when the patient leaves the office surgical suite. Patients are often amazed at how much better they see, especially colors, even as they are walking out of the room. Today, it is not uncommon for patients who have had cataract surgery to be seeing as good as 20/20.

Cataract surgery has had amazing advances over the last 30 years, and there will be many more advances in the future. Fortunately, in the United States, we are not yet under the constraints of a system of socialized medicine, and most patients still have, for the most part, the ability to continue to have their cataracts removed by virtue of their Medicare or health insurance.


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Dr. Richard Meister has practices ophthalmology in the Sacramento area since 1984 and is Chief Surgeon at the new NVISION Sacramento locations. For more information about LASIK in Sacramento, visit http://www.nvisioncenters.com


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