What is the future of cataract surgery going to be like? Will it be possible to modify the power of the IOL implanted after cataract surgery, so as to correct all the refractive errors of the patient and regain his best state of vision? Will it be possible to use some kind of a woundless surgery to treat cataract? Even better, can we eventually prevent the incidence of cataract?
Knowing the fact that “The turnover rate for both medical knowledge and technology is about 50% every four to five years”, it won’t be a strange thing to find a revolutionary new technology tomorrow, replacing all the current technologies and standards used for treating cataract.
Imagine a delicious M&M button candy, it is composed of a colourful outer coat surrounding a core of tasty chocolate. That’s exactly the structure of the human crystalline lens. It is composed of an outer layer or a coat (lens capsule) surrounding a core of translucent lens fibers and cells forming the core of the lens.
The aim of modern cataract surgeries is to make a central hole in the outer lens capsule in order to get access to the lens contents, then to remove all the contents leaving only an empty capsular bag – the outer colourful layer of the M&M candy –, finally, a synthetic lens – IOL – is inserted inside this bag. Remember this description well, because this is how it is in cataract surgery.
Using laser to alter the dioptric power of the IOL
Studies are being conducted on the possibility of using laser beams to modify the power of the IOL implanted after cataract surgery. This means that the IOL power can be custom-tailored to correct all the refractive errors of the patient including (near sightedness, far sightedness and astigmatism). The patient in the near future will have an operation for cataract removal and IOL implantation followed by another session to modify the power of the IOL, as if he is going to have a photorefractive surgery not for his cornea but for the implanted IOL. Moreover this photorefractive surgery will be woundless!
The era of femtosecond laser
In February 2010, the first cataract surgery operation in human history to use laser instead of ultrasound phaco probe was performed. The wide application of femtosecond laser in cataract surgery will allow for:
- Extreme image resolution of the eye allowing for perfect pinpointing of laser throughout surgery.
- Ultra small corneal wounds that will lead to diminishing the problem of astigmatism following cataract surgery, and result in perfect healing after the operation.
- Perfect well centered Capsulorrhexis (a step in the surgery through which a central hole is made in the anterior capsule of the lens – the outer colourful layer of the M&M candy – so as to get access to the contents of the lens). This will allow for a perfectly centered IOL inside the capsular bag, thus increasing the accuracy of the patient’s vision.
- An enhanced way of fragmenting and liquefying the lens contents using much lower energy compared to energy used by the modern ultrasound phaco probe. This will result in significantly decreased incidence of complications after cataract surgery.
Femtosecond laser will provide higher safety standards in cataract surgeries with increased ability to anticipate the visual outcome of the patient, post surgery.
The use of proteolytic enzymes
Recent studies suggested a novel surgical technique instead of the currently used one. In this technique, a small hole will be made in the periphery of the lens capsular bag – the outer colourful layer of the M&M candy – then a proteolytic enzyme will be injected inside the lens bag (Proteolytic enzymes are a type of chemical compound capable of breaking down complex proteins into smaller fragments. The most famous example of proteolytic enzymes is the gastric juice found inside our stomachs).
The resultant fragmented liquefied material will be aspirated and a synthetic protein gel with the same optical properties as the normal lens proteins will be injected inside the capsular bag. The initial hole will then be sealed by tissue glue. Simple as that!
Laser bleaching of the cataractous opaque lens
Yes, it is just like what you have read. Line Kessel, an ophthalmologist at Glostrup Hospital of the University of Copenhagen in Denmark, announced that he and his colleagues have researched a new technique that will allow for the restoration of the transparency of the lens fibers using laser. The laser helps the lens fibers to restore their original composition, structure and arrangement. Indeed a promising technology that will make modern cataract surgery with all the technologies implemented in it something of the past.
Other future approaches
Studies are being conducted to prevent the incidence of cataract using gene therapy. The aim of these techniques is to identify the gene(s) responsible for keeping the integrity of the normal crystalline lens proteins, so as to develop drugs capable of preserving this/ these gene(s) from alteration in composition that occur with aging, ultimately leading to preventing the incidence of cataract.
In a nutshell:
The renaissance of cataract treatment is yet to begin. In view of the rate of turnover of technology, one can understand why the ophthalmology pioneer Charles Kelman MD believes that cataracts will be a rarity 20 years from now; after all, wonders should never cease! And by this, we can say that the future of cataract surgery looks promising indeed.