Cataract Innovations

By Lisa Brothers Arbisser, MD

At Eye Surgeons Associates (ESA), we have had the privilege of delivering world class care for prevention of vision loss and recovery of vision for over a quarter of a century. We were the first in the Quad City environs to offer comprehensive eye care including glaucoma and retinal detachment surgery, laser treatments and corneal transplants complex pediatric surgery and refractive surgery. We brought the first fellowship trained sub-specialty level eye care to the community.

In the arena of cataract surgery, the world has seen tremendous innovation and the miniaturization of incisions and equipment in cataract surgery has spread to other fields of surgery. Cataract surgery has continued to improve over the years both in safety, comfort and convenience. ESA has remained on the leading edge of techniques which provide startling improvements in visual rehabilitation and function.

 The Arbissers were the first to offer outpatient cataract surgery in the Quad Cities, eliminating overnight hospital stays. We were also the first in the Quad Cities to use a Yag laser, utilized if a second surgery was needed after cataract removal, and, as close to waving a magic wand as we get in medicine, to solve this common problem. We introduced topical anesthesia using eye drops instead of injections, freeing most patients from the rare risks associated with needles around the eye and, since no patch is required, allowing even one-eyed patients to see immediately following surgery. We introduced a no-stitch incision technique to the area and then were the first to make a small self sealing incision in the cornea, which causes no bleeding allowing patients on blood thinners to continue their necessary treatment. This along with the mastery of a way to secure the manmade lens in the cataract bag called capsulorhexis has permitted patients to return to golf, bowling or tennis within days of surgery. Contrast this with the sandbagging and bed rest for two weeks of yesteryear. We now expect over 90% of patients to pass a drivers test with the operative eye by the next day versus the previous three month visual recovery time.

When we remove the cloudy cataract the focusing power of this lens is replaced with a manmade intraocular lens (IOL) which has undergone tremendous innovation. These have evolved from a rigid material to a flexible model that folds to go through the small incision and opens to its full size within the eye. ESA has continually invested in technology which refines measurements for the most accurate visual outcomes. We were among the first in the world to practice what is now commonly known as the field of refractive cataract surgery to reduce dependence on glasses and contacts both after cataract surgery and as a refractive technique for older patients without cataracts. Once, cataract surgery resulted in debilitating coke bottle glasses and now we are able to routinely give patients the choice of driving without glasses, reading without them and even, with the advent of presbyopia correcting IOL’s, both. Where the standard IOL has only one focal point (monofocal implant), multifocal IOL’s divide light energy between distance and near and some models move inside the eye to deliver clear vision within a large range. We can now treat inborn refractive errors like astigmatism, once worsened by older cataract surgery techniques, with relaxing incisions called astigmatic keratotomy or, most recently with a special IOL called a toric lens. Modern IOL’s now block out ultraviolet and extreme blue light mimicking the normal human lens and protecting the macula from light damage.

Safety and the uniformity of outcomes have improved due to pioneering techniques to break up and remove the cloudy lens material. The Kelman phacoemulsifier was responsible for driving much of the innovation in the field. This ultrasound power, which works like a microscopic jackhammer within the delicate eye, has been modified to be ever more efficient. New effective antibiotics have reduced the chances of infection and added to the safety of surgery.

At ESA, we have been leaders in the region in techniques to restore anatomy after injury to the eye with the use of capsular tension rings to secure or resuspend and center the injured lens and to create an artificial iris where the normal one has been destroyed. We have had the joy of restoring excellent vision to eyes thought lost to blindness for decades. We can restore and preserve vision in infants born with cataracts or children who have acquired them through injury at ever younger ages with IOL’s and careful management by our pediatric ophthalmologists. Patients who had little hope can now expect unprecedented visual outcomes.

We at Eye Surgeons Associates are committed to compassionate, up to the minute, comprehensive eye care historically and into the future.

Cataract Surgery innovations at a glance:

Outpatient cataract surgery (no hospital stay)
Nd Yag laser capsulotomy (for after cataract)
Sutureless incisions
Topical anesthesia (no shot no patch)
Clear corneal incisions (no bleeding)
Foldable intraocular lenses (IOL)
Peripheral astigmatic keratotomy (incisions for astigmatism)
Presbyopia correcting IOL’s (allows near and far vision without glasses)
Ultraviolet and blue filtering IOL’s (protects the macula from light damage)
Toric IOL’s (treats astigmatism without incisions)
Refractive Lens Exchange (lens based refractive surgery without cataract)
Diagnostic equipment: topography, IOL master biometry (accurate lens measurement)
Therapeutic equipment: phacoemulsification, non-continuous strategies, torsional ultrasound (safest cataract removal)
Technique changes: capsulorhexis, phaco chop, pars plana vitrectomy, intraocular sutures
Fourth generation antibiotics (best prevention of infection)
Capsular tension rings (secures lens position when abnormal)
Aniridia rings (replaces missing or damaged iris)

 Eye Surgeons Associates located in Bettendorf, Muscatine, Rock Island, Silvis and Geneseo, provides comprehensive eye care for the entire family, for a lifetime. Our medical doctors are fully fellowship trained in their specialties and board certified. For more information visit us online at www.esaeyecare.com. A Princeton graduate, Dr. Lisa Brothers Arbisser, teaches cataract and anterior segment ophthalmic surgery worldwide from her Quad Cities, Iowa and Illinois practice of twenty years. Following medical school in New Orleans and Houston she pursued an NIH neurobiology fellowship. She completed her ophthalmology residency at the University of Iowa Hospitals and Clinics. She is a diplomat of the American Board of Ophthalmology and certified in cataract and implant surgery by the American Board of Eye Surgery. She is a clinical adjunct associate professor at the University of Utah John A. Moran Eye Center and a former president of the American College of Eye Surgeons.