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Doctors Continue to Enhance Cataract Treatments

They range from new surgeries to lenses that help combat vision problems

FRIDAY, Jan. 28, 2005 (HealthDayNews) -- Medical advances continue to offer brighter hope for the treatment of a cataract, the clouding of a lens that can damage vision.

For instance, sound is one of the best things to ever happen for cataract sufferers. Surgical advances utilizing ultrasonic devices have made it easier than ever to remove and replace a cataract-clouded lens, medical experts say.

Other breakthroughs involving replacement lenses mean patients often end up with better vision than they had before surgery.

Physicians are touting these advances during Cataract Awareness Month, a January event sponsored by the American Academy of Ophthalmology.

Cataracts are a common symptom of growing old; by age 80, more than half of all Americans either have a cataract or have had cataract surgery, according to the National Eye Institute.

Most age-related cataracts develop when protein in the eye's lens begins to clump up, clouding the lens and reducing the light that reaches the retina. The lens is a clear part of the eye that helps to focus light, or an image, on the retina, the light-sensitive tissue at the back of the eye.

For some people, their clear lens will slowly change to a yellow-brown color, adding a brownish tint to vision. This tint can make it more difficult to read or perform other routine activities.

"Cataract surgery has been one of the areas of medicine that has seen the most tremendous advances," said Dr. Donald Schwartz, an ophthalmologist in Long Beach, Calif., and a spokesman for the American Academy of Ophthalmology.

One of the biggest advances has been the perfection of phacoemulsification, the surgical procedure in which ultrasound waves break up a cataract-ridden lens, Schwartz said.

In the procedure, a small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. A tiny probe then is inserted into the eye that emits ultrasound waves that soften and break up the lens.

"Then those little tiny pieces are vacuumed out of the eye," said Dr. Thomas Steinemann, an ophthalmologist at MetroHealth Medical Center in Cleveland. "Within a few minutes, the cataract is gone. Once it is removed, it never returns."

After the natural lens has been removed, it often is replaced by an artificial lens, also called an intraocular lens. The lens requires no care and becomes a permanent part of the patient's eye.

Surgery also has been made easier by the creation of synthetic replacement lenses that can be folded, Steinemann said. These lenses, often made of acrylic or solid silicone, can be placed into the eye through a self-sealing incision as small as an eighth of an inch.

"You can make your incision into the eye very tiny," he said. "It's less invasive, and makes recovery time much shorter." Because the incision is so tiny, sutures usually aren't needed.

Improvements in the lenses also have meant better vision for the people who receive them.

"We want to replace the lens with a lens that acts more and more like our own human lens," Schwartz said. "Lenses that will better and better allow people to see at different distances."

Older lens implants provided clear vision for people only at one specific distance.

But new so-called multifocal lens implants come closer to mimicking the sight provided by the human eye. Formed with concentric circles resembling a practice target, the lens allows a patient to shift his or her focus through slight eye movements.

Testing is under way on a further refinement involving a device called a wavefront analyzer. The device measures the way light travels through a cataract patient's entire optical pathway, then compares it to the way light travels through an optically perfect eye.

The information from this device can be used to create lenses crafted to address the specific irregularities of a person's visual system.

"That's still in the testing stages, but it could eliminate some of the distortion that patients complain of," Steinemann said.

While the advances are reassuring, no one wants to get cataracts in the first place. The bad news is, virtually everyone eventually will get them.

"It's almost inevitable that if you live long enough, you will get cataracts," Schwartz said.

If you want to forestall the onset of cataracts, the best thing you can do is pick up a pair of sunglasses.

"Cataracts are caused in most people by a lifetime of damage caused by ultraviolet radiation," Steinemann said.

He recommends that everyone -- even children -- wear good sunglasses with ultraviolet protection when they're out in the sun.

Diabetes can be a contributing factor to cataracts as well, especially if left untreated.

You also should protect your eyes when necessary, because trauma can spur the early onset of cataracts.

"Wearing eye protection is an easy thing to do, and it's critical," Steinemann said. He suggests wearing safety glasses or goggles at work, playing sports, participating in hobbies, or indulging in any activity that causes risk to your eyes.

Finally, smoking also puts you at risk for cataracts, Schwartz said.

"In the center core of the lens, the nucleus becomes harder and more yellow with people who smoke," he said.

More information

To learn more about cataracts, visit the National Institute of Health's National Eye Institute.

SOURCES: Donald Schwartz, M.D., ophthalmologist, Long Beach, Calif., and spokesman, American Academy of Ophthalmology; Thomas Steinemann, M.D., ophthalmologist, Metro-Health Eye Clinic, Cleveland, and associate professor, ophthalmology, Case Western Reserve University, Cleveland
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