I recall starting my residency in 1982 and a prominent attending telling me I had just missed the Golden Age of ophthalmology. Phacoemulsification was becoming more prevalent with patients, and IOLs were becoming commonplace.

“THE REPORTS OF MY DEATH HAVE BEEN GREATLY EXAGGERATED”

Fast-forward to today, and I know he was incorrect. Refractive cataract and corneal surgery has never been more dynamic, thanks to extraordinary advances in technology that seem to be expanding at a logarithmic rate. The presbyopic IOL market is poised to double in the next year alone as new low-add multifocal and extended-depth-of-focus IOLs improve quality of vision, providing patients a low-risk option for spectacle independence with quality vision after cataract surgery.

Trifocal IOLs, available outside the United States, are expected to enter here as well. The femtosecond laser for cataract surgery continues to improve, making cataract surgery more predictable, with better primary incisions, arcuate incisions, capsulorhexis and lens fragmentation.¹

MORE TO COME

And that’s not all: Multiple new technologies are waiting in the wings including, for the first time in 50 years, a new energy source for performing cataract surgery (YAG laser) and better fluidics that both reduce the energy required to remove a cataract and improve safety.

A number of accommodating IOLs are now in trials and will someday become the dominant lens for cataract surgery, while light-adjustable IOLs will improve our ability to achieve our refractive target.

A SECOND WIND

Refractive corneal surgery is also undergoing a renaissance. Laser vision correction was approved by the FDA on Oct. 20, 1995. At that time, one FDA trial showed that 80% of patients achieved 20/20 UCVA, and 98% had 20/40 or better UCVA. Only 6.8% of patients lost two more lines of BCVA.

While refractive corneal surgery has not become commonplace, a second generation of patients are entering the market in enormous numbers as Generation Y reaches the age for laser vision correction. LASIK, PRK and now SMILE (SMall Incision Lenticule Extraction) have never been safer or more precise.

The recent FDA trials for new laser systems, such as second-generation wavefront aberrometry and topographic lasers, show that more than half of our patients will not see 20/20 after their procedure, they will see better. When patients can expect to see better without glasses following refractive corneal surgery than with their best glasses pre-op, expect patient interest to follow.

Results published last year from the FDA’s PROWL 1 and 2 studies showed that 99% and 96% of subjects, respectively, achieved 20/20 bilateral UCVA, with no enhancements needed.² The study also demonstrated LASIK’s safety. Most patients who experienced glare and halo before LASIK actually had a significant reduction in these symptoms after LASIK with improvement in their quality of vision.

Corneal inlays are now offering a viable treatment for presbyopia.

Ophthalmology’s partnership with industry has been a vital relationship in improving patient outcomes in corneal and cataract surgery. Innovation, key to our mutual success, has never been more vibrant than it is today.

My mentor was incorrect. The Golden Age of anterior segment surgery is now, and the future? Even brighter. OM

REFERENCES

1. Grewal DS, Schultz T, Basti S, Dick HB.Femtosecond laser-assisted cataract surgery--current status and future directions. Surv Ophthalmol. 2016 Mar-Apr;61(2):103-31.
2. LASIK quality of life collaboration project. https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/SurgeryandLifeSupport/LASIK/ucm190291.htm . Accessed Oct. 6, 2017.

Eric Donnenfeld, MD, FACS, is a board certified ophthalmologist and experienced corneal surgeon. A professor of ophthalmology at NYU and a trustee of Dartmouth Medical School, he is a consultant for numerous ophthalmic companies. He may be reached at ericdonnenfeld@gmail.com.