health & wellness

Common Problem

Those needing cataract surgery can go with laser or traditional.

Ruthan Brodsky
Special to the Jewish News

Today, most cataract surgeries are out-
patient procedures with minimal anesthe-
sia, tiny incisions, quick recovery and high
ust like a camera has a lens, so
success rates. Patients make the decision
do your eyes. A cataract is a
when to have the surgery based on how
ibill cloudy formation on the natu-
much the cataracts impact their lives, such
ral lens of the eye, and surgery is the
as not being able to drive at night or not
only option to have it
drive at all. The surgery
removed. Today, there
is usually done on one
are two types of sur-
eye at a time and most
gery: traditional and
people remain awake
laser.
during the surgery,
When a cataract
although some sedation
first forms, there's
is often used.
little impact on your
Traditional cataract
vision. If left untreat-
surgery is the most
ed, however, it can
common type used to
continue to grow and
remove cataracts. It
cause blurred vision or
is a procedure highly
blindness.
dependent on surgeon
skill, volume and
The good news is
that cataracts can
experience. A surgeon
almost always be suc-
uses a surgical blade
to make a small inci-
cessfully treated with
Dr. Steven Shanbom
surgery. In fact, mil-
sion in the cornea, the
lions of cataract sur-
rounded outer surface
geries are performed
of the eye using a
hand-held blade. A
each year in the U.S.
with little risk for
thin ultrasound probe
complications. During
is inserted into the
the procedure, the
lens, breaking up the
eye's clouded natural
clouded lens so that the
lens is removed and
pieces can be removed
replaced with an arti-
by suction. The outer
ficial intraocular lens
layer of the lens
remains, which helps
(IOW to restore vision
in the eye.
support the new lens
It's estimated that
when it is inserted into
nearly 22 million
the eye and secured
Dr. Leslie Grosinger
Americans age 40
in place. Often stiches
and older have cata-
aren't needed to close
racts. That number is
the incision.
expected to rise to 30 million by 2020,
The lens implant still needs to be
and aging is the primary risk factor.
inserted with hand-held instruments
Nearly everyone who lives long enough
whether a doctor uses this traditional
will develop cataracts to some extent
method or laser surgery.
although a small number of people devel-
op cataracts in their 40s and 50s. It's after Laser Surgery
An emerging advancement in this pro-
age 60 that cataracts become a common
age-related vision problem. Nearly half
cedure is laser-assisted cataract surgery,
of those age 75 and older have cataracts,
in which a beam of laser light creates the
women being at higher risk than men.
necessary incisions for cataract surgery.
An advanced computer-guidance system,
Traditional Surgery
controlled by an experienced surgeon,
It wasn't that long ago when patients had
directs the laser over the eye to provide
to stay in the hospital after cataract sur-
precise and accurate results for the patient.
gery with sandbags on their shoulders to
"The laser allows me to create a precise
keep their head stable while they healed.
opening in the clouded lens," says Dr.
Steven Shanbom, M.D., of Berkley. "The
Many surgeons would only operate if the
patient's cataract was "mature" or "ripe"
laser then softens the cataract with preci-
and caused severe vision loss.
sion laser pulses and breaks it into tiny

46 July 17 • 2014

pieces. This softening technique allows
for a more gentle removal, eliminating
the ultrasound energy once required."
When the cataract has been removed,
Shanbom's patients are transferred to the
general operating area where he places a
lens implant in the patient's eye.
"Prior to surgery, specific measure-
ments are made so that the correct power
of the lens can be implanted," Shanbom
says. "However, these measurements are
taken while the patient still has a cata-
ract inside the eye and the power of the
implant may be off. I use a system called
ORA (OptiWave Refractive Analysis),
which recalculates measurements of the
eye, either validating the power of the
implant selected or recommending a dif-
ferent power. This gives me the option
of changing the power of the implant at
the time of surgery, reducing the need to
re-operate.
"This is especially important for a
patient who had prior RK Lasik surgery,
which changes the shape of the eye," says
Shanbom, who performs both traditional
and laser cataract surgery. "After Lasik, it
is critical that the difference in shape of
the cornea is accurately measured."
Sheyna Wexelberg-Clouser of Oak Park
recently had laser cataract surgery per-
formed by Shanbom.
"I was very nearsighted and wore glass-
es since the fifth grade," said Wexelberg-
Clouser. "I had lenses implanted in both
eyes a few months ago, and today I'm
driving without glasses. My vision is still
adjusting, but I'm healing and love what I
can now see."
Dr. Leslie Grosinger, M.D., of the Eye
Surgery Center of Michigan in Troy, per-
forms both types of cataract surgery.
"Laser cataract surgery is a rapidly
advancing technology making the surgi-
cal procedure more efficient and safer,"
he says. "It is also considered less risky
because it can make a strategically
placed incision without using a blade and
without taking the surgeon's experience
into account. It also softens the cataract
using less energy than the traditional
procedure, reducing the risk for potential
complications such as bleeding or retinal
detachment."
Even so, cataract laser surgery is new.
The FDA first gave approval to several
laser companies for laser cataract surgery
in 2011.
"There are no large clinical studies
claiming that laser cataract surgery is a
superior technology than traditional sur-

gery by an experienced cataract surgeon,"
Grosinger says.
The surgical procedure takes less than
an hour, although patients may spend
more time in recovery. Laser cataract sur-
gery usually takes longer than traditional
cataract surgery because the patient
is first treated with the laser and then
moved to the operating room for comple-
tion. Moreover, using lasers doesn't seem
to improve recovery time. Most people
are mobile the same day as surgery and
back to normal vision and activities in a
few more days.
Last year, Grosinger performed laser
cataract surgery on Marty Goldman of
Farmington Hills.
"I used to have outstanding vision
as a young man, later I needed reading
glasses, and not that long ago I couldn't
drive at night. I had developed cataracts
and couldn't see very well.
"Last year's cataract surgery went very
well," he says. "There was no pain, no dis-
comfort, and I was amazed at the result
especially since I didn't feel anything.
The procedure seemed so simple, but the
results were immediate. I see so much
better and can drive at night."
The standard artificial (intraocular)
lens used in cataract surgery basi-
cally corrects distance vision. Insurance
policies generally cover the cost of these
lenses although patients may still require
glasses or contacts for close-up vision.
Today, there are also premium lenses
available that reduce the need for glasses
that are more costly and not usually cov-
ered by insurance.
There is no research that states laser
surgery is better than the conven-
tional method for removing cataracts.
Consensus is, however, that as laser sur-
gery for cataracts continues to advance
and the technology is refined, it's likely
that the use of lasers in cataract surgery
will become more widespread and fre-
quent.

❑

Cataract Symptoms

People with developing cataracts
usually experience one or more of
these symptoms:
• Cloudy, blurry or double vision
• Glare and sensitivity to bright lights
• Faded colors
• Difficulty reading
• Difficulty driving at night