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Ridley Medal Lecture highlights progress in cataract surgery over four decades
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LONDON — The 2014 Ridley Medal Lecture, held during the European Society for Cataract and Refractive Surgeons Congress here, highlighted the progress of cataract surgery over four decades and looked into future perspectives.
After recalling his personal encounter with Sir Harold Ridley in the economy class on a flight to the United States, Günther Grabner, MD, explained how little could be offered to cataract patients in those days.
“We had no microscopes, did 180° incisions, used big scissors, had no IOLs, closed the wound with up to seven sutures and the patients stayed in hospital for 5 to 7 days,” Grabner said. “Aphakic spectacles gave poor optical quality, 30% image magnification and ‘Jack-in-the-box effect.’”
Additionally, Grabner said, endothelial cells loss of 20% was the average, vitreous loss occurred in 10% of cases and macular edema was frequent.
“Safety has remarkably improved since then,” Grabner said.
However, full permanent restoration of visual function, a second goal of cataract surgery, is a mission that has not yet been completed, according to Grabner.
Biometry is sufficiently accurate in 90% to 95% of the cases, he said, but there are outliers. Astigmatism control is not fully achieved in all patients, and secondary cataract still develops in 40% of cases.
“The crucial issue of correcting presbyopia has not yet been fully addressed. There are different lenses, but no clear-cut answer,” he said.
Grabner said he favors the corneal inlay solution and has obtained successful results with the AcuFocus Kamra inlay.
Finally, Grabner emphasized the advantages of femtosecond laser-assisted cataract surgery in terms of reproducibility, safety, control and outcome quality.
With 16,000 cases successfully performed in the last 2 years, proper management of logistical aspects and utilization of resources, a high-volume of patients can be treated with femtosecond laser also in a non-profit university clinic, Grabner said.