No-Stitch Cataract Procedures

A cataract is a clouding of the lens in the eye, which interferes with light passing through to the retina. This clouding results in blurred and lost vision. Many people suffering from cataracts describe the visual distortion as being similar to looking through a waterfall or a piece of wax paper. They may also complain of night halos, excessive glare or double vision. Cataracts are most commonly found in people age 60 and over. They are often the result of the natural aging process of the lens in the eye. However, cataracts can also be diagnosed in much younger individuals. They can be the result of a previous eye injury, chronic use of steroid drops or they can be inherited.
Because a cataract cannot be seen by the naked eye, the eye doctor must dilate the pupil and examine the lens under a special microscope to see if a cataract is present. Once a cataract has been diagnosed, it must be surgically removed in order to restore clear vision. To date there is no known treatment to prevent the development of cataracts.
OMNI EYE CENTERS of Kansas City offers the most advanced cataract surgery available today, implementing a method known as phacoemulsification. The eye surgery is performed on an outpatient basis under local anesthesia. A complete physical examination is required prior to the surgical procedure to ensure the patients overall health. During the surgery an ultra sound emitting probe is directed at the cataract. These high-energy sound waves break the cataract into tiny, microscopic pieces, which are gently suctioned, from the eye. The procedure is performed through a small incision which is self sealing, requiring no sutures. Most people report improved vision quickly following the surgery and are able to return to their normal activities within two days.
Because the eye surgeon removes the natural lens of the eye during surgery, it is necessary to substitute an artificial lens known as an intraocular lens into the eye. The intraocular lens functions in the same manner as the natural lens, focusing light rays directly onto the retina to produce clear, sharp images.

Temporal Clear-Corneal Incision (No Stitch)

Yes, even the most modern techniques in cataract surgery require that an incision be made in the eye. No, cataract surgery cannot be performed with lasers (a common misconception; so called "secondary cataracts" can be treated with laser, but secondary cataracts only occur in eyes that have already had cataract surgery).
Over the past 20 years or so, incision size has come down from 16, to 12 to less than 3 millimeters in length. With the very small incisions used today, the preferred location of the incision has also changed. It is now possible to make micro-incisions in the temporal clear cornea, rather than the superior, sub-conjunctival, or "scleral-tunnel" approach. The principle advantages to temporal, clear-corneal incisions are: (1) they induce very little trauma, and therefore heal faster; (2) the cornea can be completely anesthetized with drops only, thereby facilitating topical anesthesia; and (3) they are easier to make, and safer to use for both the patient and the surgeon. We are not aware of any substantial disadvantage to the temporal, clear-corneal incision.
Because this type of incision is so small, it does not require a stitch to close it.

Phacoemulsification ("fake-o-E-mull-sa-fa-kay-shun")

Phacoemulsification or Phaco is the modern method for removing cataracts utilizing high energy ultrasound. Using this technology, a cataract which measures 12 millimeters in diameter and 4 millimeters in thickness can be vacuumed through an incision which measures only 3 millimeter or less! Basically, phaco uses a hollow needle which, when activated by the surgeon, vibrates at 40,000 times per second thereby emulsifying the cataract. Emulsified cataract is aspirated through the hollow center in the phaco needle, and fluid is simultaneously infused into the eye in order to keep it "inflated" during surgery. Cataracts CANNOT be removed by laser.

 

Foldable Lens Implant

The final step in cataract surgery is lens implantation. Prior to the development of safe intra-ocular lens implants, anyone who had their cataracts removed was forced to wear incredibly thick and heavy glasses, or contact lenses to correct their vision to normal. A typical "three piece" lens implant looks like a miniature, round magnifying glass, about 6 millimeters in diameter, with two wiry attachments called haptics. The haptics extend out to a total diameter of about 13 millimeters, and when slightly compressed, they suspend the lens implant inside the lens capsule (which you may recall, has a diameter of only 12 millimeters). Obviously a rigid six millimeter lens, with haptics that extend out to 13 millimeters is not going to fit through a 3 millimeter incision.
Flexible, or foldable lens implants however, can be rolled up into special insertion devices and "injected" through tiny 3 millimeter micro incisions. Once unfolded inside the eye, the wiry haptics suspend the implant inside the same space formerly occupied by the cataract. After a few weeks, the haptics heal into place and further stabilize the implant. "Plate" lens implants are also available. Although made from a single piece of silicone, plate lenses also have haptics, and a central lens or optic. The image above shows a foldable plate lens implant unfolding as it is injected into the eye.
Before cataract surgery, we will make measurements on the eyes that assist us in selecting the correct lens power. Usually the power is selected to optimize your distance vision. In other words, by controlling the power of your implant, your surgeon can correct any pre-existing near-sightedness or far-sightedness.

 

For those individuals with astigmatism, a cornea that is shaped like a football, our surgeons can perform a procedure known as Astigmatic Keratotomy during cataract surgery to reshape the cornea into a sphere. This will reduce the individuals need for glasses after the surgery.

 

Refractive Lensectomy

A Refractive Lensectomy is a procedure that treats nearsightedness and farsightedness by removing the eye’s natural lens and replacing it with an Intraocular Lens with the appropriate corrective power. The procedure is similar to cataract surgery, however; there is no cataract present.
The procedure is performed under local anesthesia on an outpatient basis. A small incision is made in the eye in order to remove the natural lens and insert the IOL. The entire surgery takes about 30 minutes.  The surgeon can perform a procedure known as AK at this time to treat any astigmatism that may be present in the eye.
Refractive Lensectomy is available for patients who are over 40 years of age and those patients who may not be good LASIK candidates. There are different IOLs available for patients to choose including the multifocal lens implants – ReSTOR®, ReZoom™ and Crystalens™.  Patients who choose monovision or a multifocal lens may not need glasses for near vision very often following the procedure.
As with all eye surgery, there are risks. You should be educated to the benefits and risks prior to the procedure.

 

 

ADDITIONAL COMMONLY ASKED QUESTIONS

Can cataracts be removed by laser?

No.  Not really.
If you have been here (to this part of my web-site) before, then you know that this used to say NO.  Well, earlier this year (2001) the FDA did approve one machine for laser removal of cataracts, but it hasn't caught on with cataract surgeons, and it isn't really what you would expect.  The beauty of lasers is that they promise surgery without an incision.    However, with the currently available laser technology, incisions must still be made, and from what I understand, the laser is not as versatile as the now standard ultrasound based methods (phacoemulsification).   Research continues in this area, but with very very few exceptions, lasers are not currently used for removing cataracts. Modern small incision cataract surgery utilizes ultrasound to liquefy (emulsify) the cataract.
Actually, the only possible advantage that lasers hold in cataract removal is that they may eventually allow even smaller incisions to be used.  Currently we use an incision of slightly less than 3 millimeters, which is very small.  In fact, you  cannot use a significantly smaller incision, because if you try, then you cannot implant an artificial lens at the end of the case.  New lens implant technology that allows lenses to fit through even smaller incisions will need to proceed the acceptance of lasers as a method to remove cataracts.

Can cataracts grow back after surgery?

No.
A cataract once removed, cannot grow back. However, during cataract surgery the "posterior capsule", a very thin, clear membrane which wraps around the back side of the cataract is left intact, and eventually this becomes cloudy. This so called "secondary cataract" can be treated with a YAG laser. This is a painless office procedure which restores vision in a matter of minutes to patients with "secondary cataracts".