Stanford Medicine Newsletter Updates For the Local Community

 

Changing perspectives on cataract surgery

Mary Savoie is back to doing the activities she loves, thanks to a new laser technique used for her cataract surgery.

   

At age 80, Mary Savoie had developed cataracts that interfered with many of her favorite activities. An avid reader, she’d begun to struggle with the words on the page. The stress of playing bridge, another of her favorite pursuits, made her eyes feel dry. And her vision had become so impaired that she had stopped driving at night.

“I might not have had any place to go, but it made me feel trapped,” she said. Like one in every two people her age, Savoie was dealing with vision so limited by the yellowing in her eyes that she needed surgery to regain a full and active life.

In the spring, she became the first patient at the Byers Eye Institute in Palo Alto—and one of the first in California—to have a cataract removed with the help of a new laser procedure.

Eye issues

Each year 3 million Americans have their cataracts removed through an approach that has not varied for years: With hands trained by years of careful practice, ophthalmic surgeons follow the circular outline of the eye’s lens to reach the tissue hardened by time and score its surface with ultrasound so it can be removed and replaced with an artificial lens.

Savoie had the procedure done with the help of a laser that her eye surgeon describes as “one of the most amazing things to come along in cataract surgery.” Her vision is so improved that she says she was a child when she last saw the sky so blue. “I can’t tell you how wonderful I feel,” she said. And because she had one cataract removed with the laser and the other by the traditional approach, her experience gives her a special perspective.

The advantages of the laser begin with its precision. “Creating a circular opening in the lens capsule is a critical step in cataract surgery,” said Artis Montague, MD, director of cataract surgery services at Stanford and director of the operating rooms at the Byers Eye Institute. “Experienced surgeons are quite good at creating these circles. I’ve drawn thousands of them and can create that circular opening very well. But compare me making that circle to a laser making that circle, and the laser is going to be perfect every time.”

The laser’s edge

That perfection, guided by a three-dimensional scan of each patient’s eye, is just one benefit. Because the laser breaks the cataract into a latticework of tiny squares, the surgeon can remove the cloudy lens with far less ultrasound energy. The difference in inflammation and impact on the patient is substantial compared to traditional surgery. Nearly a month after the traditional procedure on her left eye, Savoie still feels the grittiness that patients typically experience. In her right eye, done with the aid of the laser, she feels nothing but that dramatic improvement in vision.

“The difference is phenomenal,” Savoie said. “I would highly recommend this new process.”

Montague, who said she is conservative by nature and cautious to adopt new things, is impressed by the innovative technology, which was co-invented by researchers at Stanford and tested in clinical trials at Stanford and elsewhere before receiving federal Food and Drug Administration approval.“I went into medicine to help patients, so for me it’s very satisfying,” Montague said. “Patients are happier. It feels safer. Time will tell, but I think it has the potential to change cataract surgery tremendously.”

Precision and control

Laser technology has been used for decades to reshape the cornea as a way of correcting nearsightedness, farsightedness and astigmatisms. The challenge of using lasers in cataract surgery is to control its intensity to avoid collateral damage to surrounding tissue, the retina and other parts of the eye yet still power the precise incision required to remove the cataract.

The new technology, known as the Catalys Precision Laser System, uses a noninvasive imaging technique to create a three-dimensional, computerized map of the eye as a pattern for the laser to follow. The pattern is then superimposed on a three-dimensional image of the patient’s eye to confirm for the surgeon that the laser is on target. It also allows the surgeon to monitor the laser’s incisions.

The reduced energy needed to remove the lens lowers the risk of infection and damage to surrounding tissue, including the corneal epithelium, and minimizes other complications.

Nearly 60 years ago, Savoie’s mother had cataracts removed from both of her eyes. “She was a week in the hospital with sandbags on each side of her head the whole time,” Savoie said. “When I think about that, I think how amazed she would be now.”

Learn more about the Byers Eye Institute at stanfordhospital.org/eyeinstitute

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