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Seeing clearly: Cataract surgery shows visible improvements

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Not everyone who wears glasses with lenses the size of those on the Hubble telescope came by them naturally. For some, those glasses are a byproduct of surgery they had for cataracts - back in the days when cataract surgery was in its infancy.

"The process has been refined to the point that patients are conscious during surgery these days," said Stephen Reck, an ophthalmologist with Clarus Eye Centre, which has facilities in Lacey and DuPont. "Some even opt not to have anesthesia. They're up and moving around with little or no pain an hour after surgery. And best of all, they don't need high-powered lenses to see."

That hasn't always been the case in efforts to remedy the clouding in the crystalline lens of the eye. Pioneers in the removal of cataracts made a very large incision - almost 180 degrees - around the eyeball so they could open the eye and remove the lens. Fortunately, the patient didn't feel a thing, thanks to the efforts of an anesthesiologist on duty throughout the procedure. Artificial lens implants had yet to be developed, so patients needed very thick glasses to see after surgery. On top of that, it was risky business since complications such as retinal detachment were a constant danger. And the ordeal didn't end with the surgery itself - patients might spend a week lying in a hospital bed with sandbags on both sides of their heads so they couldn't move around during the initial stages of the healing process.

Even without the stories about how traumatic the process used to be, Reck's description of how it's done today sounds pretty benign.

First, he said, the surface of the eye where the surgeon will apply his or her skills is numbed with an anesthetic jelly. However, "the incisions are so tiny that patients usually choose not to have anesthesia," he noted.  

Just how tiny?

So small that the surgeon monitors what he's doing through a microscope. Once the incision is made, an even tinier tube is inserted into the eye to deliver highly concentrated ultrasound energy - cyclic high-frequency sound waves - to liquefy the cloudy lens and remove it through the tube.

Amazing, right?

Here's what's even more amazing: After the tube has vacuumed up all the lens particles, a replacement lens is rolled up like a wee tortilla and inserted thorough the incision. Once the artificial lens is in place, the ophthalmologist is able to unfurl it precisely where the natural lens used to be.

The incidence of complications is very low, and the healing period is much shorter and far less uncomfortable than it once was.

Moreover, artificial lenses now available can all but restore the patient's range of vision - almost, but not quite.

Take the multifocal lens, for example. Its surface is actually a multitude of very small lenses, some designed for near vision and some for distance vision. Remarkably, when the person in whom they've been implanted looks off in the distance, the eye ignores those lenses designed for close-up work and vice versa when the person is involved in an activity such as reading a book, where near vision is needed.

However, there are some drawbacks, Reck said, such as less than perfect midrange vision, and some glare and halos at night.

Another option is what's known as monovision, where one eye is fitted for seeing in the distance and the other for close up.

Both take a bit of getting used to, Reck explained, but the range of vision is often better than what cataract surgery patients experienced with their natural lenses before surgery. And they're miles beyond anything cataract patients could hope for in the past.

"We've made tremendous advances," said Reck.

The process isn't perfect - not yet, anyway - but a new generation of ophthalmological pioneers is working toward perfection as fast as it can.

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