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Lens surgery will see increase in safety in the future, surgeon says
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OTTAWA — Advances in cataract surgery and refractive lens exchange will make these procedures much safer in the future than they are today, predicted Randall J. Olson, MD, at a symposium here.
“The equipment that will be available to us in the future will be as much about safety as it will be about efficacy,” Dr. Olson said here at the Sally Letson Symposium on Cataract Surgery and Refractive IOLs.
“Cataract surgery and refractive lens exchange will be more and more alike as time goes on,” Dr. Olson said. “At present, the barriers to acceptance of lenticular refractive surgery include refractive precision, retinal detachment and endophthalmitis.”
Dr. Olson predicted improvements in the safety of each of these aspects of surgery. He said he expects that in about 25 years’ time the rate of endophthalmitis will fall to 1 in 10,000 cases from the present 1 in 1,000.
“Greatly lessening the risk of endophthalmitis will be a huge step in alleviating people’s concerns if we can cut that figure down to one-tenth of what it is today,” he said.
Dr. Olson noted that capsular rupture is now reported in about 1% to 2% of cases, and he said this should be reduced sharply in the future to 1 in 1,000 with more precise technologies.
“If a surgeon is breaking more than 1 in 1,000 capsules, that will be regarded as substandard,” he said.
Astigmatism correction will be guided by wavefront analysis or similar technologies, Dr. Olson predicted. He noted the advent of the Light Adjustable Lens, which is in development by Calhoun Vision.
“I predict the mainstay of this treatment will be light-adjustable lenses and other competing technologies,” he said.
Dr. Olson said that with such technologies allowing astigmatism correction in the implanted lens, “we won’t have healing problems of the cornea. We will be able to perform incredibly precise astigmatic corrections.”
Retinal detachment is a concern for young people with high myopia who are undergoing lens surgery. Use of phakic IOLs instead of lens exchange in these patients may reduce but does not eliminate the possibility of detachment, Dr. Olson said.
Ultrasound, today the leading technology for nucleus extraction, will be faced with possibly safer competing technologies in the future, including pulsed fluid, vortex technology and enzymatic dissolution, he said.
“I suspect there are technologies that we haven’t even thought of yet that will become standards of treatment,” Dr. Olson said. “Change will happen rapidly. No one technology can remain predominant indefinitely.”
Dr. Olson said patients will come to expect high levels of safety and excellent outcomes in lens surgery.