This surgery has continued to evolve over the past several years, often leading the way for our medical colleagues. Years ago ophthalmologists were the first to utilize microsurgery techniques. The microscope came into use for the cataract surgery nearly 20 years ago. Ophthalmologists also pioneered the use of lasers for surgery.
Cataract surgery has continued to require a smaller and smaller incision over the years. About 10 years ago, the average cataract incision was nearly 11 or 12 millimeters. Now with phacoemulsification, the cataract is removed with a vibrating handpiece. This requires an incision no more than 3 millimeters (1/8 inch).
Flexible lens implants can be folded in half and can be passed through an incision nearly as small as the phacoemulsification needle itself. As the incision has shrunken, the need for sutures has diminished. In the great majority of cataract surgeries, no sutures are required.
The advantages of this new small incision surgery are quite significant. Because the wound is smaller, the eye is more stable. Therefore, the customary restrictions against bending or heavy lifting are dramatically shortened. We now tell patients that these limitations need only last 3-4 days. After this time, the patient can resume normal activity.
Another major advantage of the small incision is that it causes much less distortion of the vision. Patients have found that their vision recovers quite well in just several days.
Typically, we still wait 3-4 weeks before we order glasses to be sure that the prescription is as accurate as possible. The number of office visits required following cataract surgery has also dropped. We now see patients the first day, the first week and in 1 month following cataract surgery.
Another very significant advance in cataract surgery has been our ability to combine the small incision cataract surgery with a glaucoma procedure. This combined operation enables us to take care of both problems in certain patients. With the double operation, however, the visual recovery and necessary postoperative visits are both prolonged.
A final, very exciting advance in cataract surgery has been the use of topical anesthesia.
Previously, patients were given an injection of anesthetic agent behind the globe. This injection would paralyze the eye muscles and prevent movement of the eye. Patients tolerate this type of anesthesia very well and we give it in such a way that the injection is painless. However, very occasionally, patients can develop a small hemorrhage from the injection. Another disadvantage is that the eye has to be patched following the injection because it is anesthetized.
With topical anesthesia, we administer local anesthetic drops into the eye prior to the surgery. The drops provide very adequate anesthesia to the anterior portion of the eyeball, and the surgery can be performed pain-free. Additionally, the patient can continue to move their eye and can sometimes even help with the surgery by looking in certain directions for the surgeon. The patient does not require a patch following the procedure, and they can leave with just a pair of regular sunglasses.