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Ophthalmology’s Greatest Hits: Cataract Surgery

My last article listed the five most significant developments in eye care over the past 25 years, chosen by ophthalmologists. I have practiced during this entire period of incredible and sometimes miraculous innovations. So, here’s my list of ophthalmology’s greatest hits:

  • State-of-the art cataract surgery
  • Treatment of macular degeneration
  • Treatment of diabetic eye disease (diabetic retinopathy)
  • Advances in the diagnosis and treatment of glaucoma
  • Treatment of dry eyes

In the 1970s cataract surgery took about an hour, required hospitalization of 1-3 days, was reserved for the worst cases and entailed significant risk. Now this 10-minute procedure occurs in outpatient surgery centers and is safely performed on anyone with vision loss from cataracts.

Technological advances including miniaturization and computerization have revolutionized cataract surgery. One of the pioneers of modern eye surgery, Charles Kelman, struck upon the idea of removing a cataract by breaking it into tiny pieces using ultrasound and then sucking these fragments up into a tiny probe. This technique called phacoemulsification allows for a much smaller incision into the eye, resulting in faster recovery and many fewer complications.

Before the development of intra-ocular lens implants (IOLs) in the 1970s and ’80s, either thick Coke-bottle-type glasses or contact lenses were used to restore vision after surgery. Better than blindness from cataracts, both of these options for vision restoration were terrible by today’s standards.

Intraocular lenses gained wide acceptance in the 1980s as designs and manufacturing processes improved. Today, all cataract surgery is performed with implants. Phacoemulsification requires a tiny incision of about 1/8” but implants in the 1990s were twice the diameter. The next major development was implants that could be folded in half.

These developments have made cataract removal the most commonly performed and most successful major surgery performed throughout the world.