PUBLICATION EXCLUSIVE: PCO treatment would disrupt cataract surgery

The No. 1 unmet need in cataract surgery today is a safe and effective method to prevent posterior capsular opacity. Our inability to conquer the biology of the lens capsule and subcapsular epithelium after cataract surgery, which includes epithelial cell proliferation, fibrous metaplasia of cells resulting in capsular haze/fibrosis and secondary capsular contraction, is not only a cause of significant vision loss for our patients but also a major barrier to the development of a functional accommodating IOL. Amazing to me, no major strategic has focused significant resources on solving this problem.

In the U.S., Medicare statistics suggest that the incidence per year of YAG laser capsulotomy is about 25% the incidence of cataract surgery. We do 4 million cataract surgeries a year in the U.S. and just under 1 million YAG laser capsulotomies. That generates a cost of about $400 million to our medical system, not including the costs of time off for patients, family and caregivers. And while YAG laser capsulotomy is certainly a straightforward procedure, it is not totally without complications, and it definitely places a significant burden on patients, families and third-party payers.

Many, if not most, patients with high-quality Snellen visual acuity and contrast sensitivity at 3 months after cataract surgery later suffer a slow but continuous deterioration in the quality of their vision from PCO, similar to the visual loss they experienced when they first developed a cataract. They are disappointed when they require a second procedure to treat it. Even worse, in emerging countries where YAG laser capsulotomy is simply not available, patients with poor understanding and access to care can suffer from a repeat of the visual disability their cataract caused secondary to PCO with no opportunity for treatment.

Many attempts have been made to prevent or reduce PCO over my 40-year career. These include cryotherapy, radiation, irrigation of the capsular bag with distilled water or antimetabolites, and immune therapy, to name a few. Careful polishing of the posterior capsule and undersurface of the anterior capsule mechanically or with laser or ultrasound can be helpful, but it is not preventive. A square-edged posterior chamber lens can retard but not prevent PCO. Separation of the anterior and posterior capsule, as done by the Visiogen Synchrony IOL, seemed to effectively reduce PCO in clinical trials, but no IOL that does this is FDA approved. Thus, there is really no truly effective treatment to prevent PCO today.

Click here to read the full publication exclusive, Lindstrom's Perspective, published in Ocular Surgery News U.S. Edition, June 25, 2017.