News

This issue is the 200th of Uday Devgan, MD’s “Back to Basics” column for Eye Surgery News.These columns have been instructing novice and experienced surgeons alike in all aspects of cataract surgery and provide valuable assistance to the practice of surgery.I would like to thank and congratulate Uday for his contribution to the publication and his contribution to perfecting the art of cataract surgery.
In the fall of 2005, I started this “back to basics” column in collaboration with the editors of Healio/Ocular Surgery News, reviewing the fundamentals of cataract and refractive surgery.
Now, almost 17 years later, and at number 200 in our monthly magazine, eye surgery has changed a lot, especially refractive cataract surgery.The only constant that seems to be constant in eye surgery is change, as our techniques and techniques continue to evolve every year.
Phaco machines have made great strides in jet and ultrasonic energy delivery.Previous techniques were incisions 3 mm wide or larger, using gravity infusion and limited ultrasound power modulation.Modern machines now offer forced infusions, active pressure monitoring, and advanced power modulation for more stable anterior chambers.Ten years ago, we dabbled in dual-hand phaco to separate the infusion from the phaco needle, which was used without a silicone cannula.While this allowed the use of two cuts, each less than 2mm wide, it was not widely adopted in the United States.We now go back to coaxial ultrasonography, albeit with a smaller incision, in the mid-2mm range.Our ultrasound systems now provide unprecedented safety and precision for cataract surgery.
There were multifocal IOLs 200 months ago, but their designs were even cruder than what we have today.Newer trifocal and bifocal diffractive IOL designs provide a wide range of good vision without glasses.In the past, toric IOLs were primarily designed with silicone sheet haptics, which did not have the stability of the hydrophobic acrylic IOLs we use today.We also offer toric IOLs in various degrees and in a variety of different IOL designs.We’ve come to the conclusion that smaller is not always better, and we’d rather have a great IOL that requires a 2.5mm cutout than a smaller model that needs to go through a 1.5mm cutout.Extended focal length lenses continue to evolve, and new designs to accommodate IOLs are in the pipeline (Figure 1).In the future, adapting intraocular lenses will be able to restore truly youthful vision to our patients.
Our use of intraocular lenses has significantly improved refractive accuracy, which has brought refractive cataract surgery to the forefront.Better biometrics, both in axial length measurements and corneal refraction measurements, have greatly improved refractive accuracy and are advancing further with better formulations.We are now at a point where the idea of ​​a single static formula will soon be replaced by dynamic and evolving shot calculation methods using crowdsourcing and artificial intelligence.With a future self-calibrating eye biometer, patients can take measurements on the same machine before and after cataract surgery to collect data for continuous improvement in refractive outcomes.
Our surgical techniques have come a long way in the past 200 months.While the basics of intraocular surgery still exist, we have built on it to achieve better outcomes for our patients.All surgeons should look at their current technology and acknowledge that the way they operate today is better than it was 10 years ago.Femtosecond lasers, intraoperative aberrometers, digital surgical guidance systems, and head-up 3D displays are now available in our operating rooms.The use of anterior chamber IOLs is decreasing with several different methods of securing the IOL to the sclera.Within subspecialties, entirely new surgical categories have been developed, such as minimally invasive glaucoma surgery and lamellar keratoplasty.Even intraocular lens extractions, often used for the densest cataracts, have evolved from standard extracapsular extractions (requiring multiple sutures to close an incision made with scissors) to manual small incision cataract surgery techniques, which Features shelving cuts for better sealing in less time, and sutures, if any.
I still like to receive the print version of Healio/Ocular Surgery News at my desk twice a month, but I also find myself reading Healio emails almost daily and frequently browsing the online versions of my favorite publications.The greatest advance in surgical learning has to be the widespread use of video, which we can now enjoy on our phones and tablets in high-definition.In this regard, 4 years ago I created a free teaching site called CataractCoach.com that publishes a new, edited, narrated video every day (Figure 2).As of this writing, there are 1,500 videos covering all topics in cataract surgery.If I could keep 200 months, that would be about 6,000 videos.I can only imagine how amazing the future of cataract surgery will be.