A look back at what happened in the fields of cataract & refractive surgery in 2007 and what we can look forward to in 2008.
We are hearing so many people these days saying that cataract and refractive surgery are merging into one discipline. Perhaps this is the reason why it has been difficult to separate the two into individual feature sections in their own right.
Indeed, there will always be a crossover, particularly in the field of intraocular lens (IOL) research and development. In fact, it is IOL innovations that form the basis of a large proportion of this article, which has tapped into the minds of some great European surgeons, to see what they felt were the events that shaped their practice and industry in 2007.
Read their opinions on some of the latest advances in surgical techniques, technologies and devices and also hear their predictions on what they think will be hitting the headlines in 2008 and in years to come.
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The rise of the multifocalsAccomodating lenses could render all others obsoleteAspheric lenses failed to win the hearts of surgeonsMicroincision cataract surgery: has bimanual had its day?Accommodating IOLs could spur a bimanual MICS revivalAll quiet on the phaco frontImaging & diagnostics going from strength to strengthAre surgeons following the recommendations of the endophthalmitis study?Is LASIK losing its popularity?New technology gets the thumbs upThe rebirth of surface ablationsFemtosecond vs microkeratome: the battle continuesFemtosecond laser a feasible treatment option for presbyopia…and still the patients want moreThe pressure is on for the lenses tomorrow
IOL innovations: are we there yet?
Without a doubt, one of the hottest topics in cataract surgery has been the new premium IOLs, specifically the multifocal, toric and accommodating lenses. New designs have yielded improved visual outcomes, less complications, happier patients and, of course, more contented surgeons. But when we consider how much progress has been made in lens research and development, one question remains: are we completely happy with what we have now?
Although the new generation of multifocal IOLs have changed the face of cataract surgery dramatically - surgeons can now treat presbyopia and decrease spectacle dependence - they do not present the perfect solution for all patients. For example, glare and halos are likely with some models and the inability of the lenses to correct vision at all distances has forced some surgeons to mix and match different types of lenses in certain patients.
Some also feel that the accommodating IOLs that are currently available have simply provided a small glimpse of the potential that this exciting lens class can offer.
Nonetheless, everybody is talking about IOLs. Despite the fact that R&D has yet to yield the perfect solution for all patients, one cannot deny that we've come a long way.
"Toric IOLs marked one of the most significant developments this year," said Jorge L. Alió, MD, PhD. Although lenses, such as Acri.Tec's bitoric lenses, STAAR's toric ICL and Ophtec's Artisan toric lens have been available for some time, their use has certainly become more widespread in the past 12 months. Pavel Kuchynka, MD, was in agreement; specifically he felt that Alcon's AcrySof toric IOL signified one of the biggest market developments in cataract and refractive surgery in 2007.
These astigmatism-correcting IOLs have been praised for their ability to provide cataract patients with good refractive correction for the astigmatic cornea in a single procedure.
Furthermore, H. Burkhard Dick, MD, has been impressed by the toric foldable iris fixated phakic IOL, i.e. the Artiflex/Veriflex (Ophtec/AMO), particularly because this lens is implantable through a small incision, thus inducing less astigmatism. "Not only can we treat ametropia with this lens, but we can also treat astigmatism and we can do this in one step without the need for an additional procedure, such as a limbal relaxing incision. This is great," enthused Professor Dick.