I did some of the controls software for an automated IOL manufacturing line roughly 8 or 9 years ago. It's very cool technology, I was proud to work on it.
One problem at the time (at least from my understanding) was actually that some people needed a second round of surgery since people are living longer and cataracts are getting corrected earlier. Last I heard, the rate of complications for a repeat surgery is significantly higher, but I assume it is improving all the time.
A fun fact: UV protection can be put directly into the lens to protect your retinas even without sunglasses (I assume this depends on the polymer type though). Also the lenses are usually tinted a slightly yellow color since our natural lenses shift color as we age. Patients tend to find it jarring if the lens is perfectly clear.
> Last I heard, the rate of complications for a repeat surgery is significantly higher, but I assume it is improving all the time.
My complications apeared 2 years after the cataract procedure but were solved through laser capsulotomy, not sure if you're referring to that. But the capsulotomy is basically trivial compared to the main procedure.
My wife had both eyes done over the past year. I would guess that her new lenses did not have UV protection, because she has a most interesting side effect.
Basically, certain glass will (to her) essentially fluoresce in sunlight, so to her, it looks bright, bright purple. The glass in question looks like a slight, smoky grey to me, as does the glass vase at home with the same effect. I'd have to look for the link, but essentially, the new lenses filter less UV than the natural ones, and she's got a bit of sensitivity into that range of the spectrum.
Similarly, a carved item made from yooperlite has the crystals showing orange to her in sunlight, where the rest of us need to hit it with a UV flashlight.
>> Patients tend to find it jarring if the lens is perfectly clear.
Yeah, funny. Light it up !
For.. reasons.. I only had one eye done for a bit and, boy, did the world look different with the old and new lens. Christmas trees, for example, either looked like lit with lemon lights or bright lights. I decided to do the other eye too and the world looks bright again... from both eyes.
A shame that cataract surgery has become a money making scheme in some countries (Canada), where surgeons often push unnecessary expensive lenses to patients and focus exclusively on simple cataract cases to fuel their high income lifestyles.
> In 4,000 years, cataract surgery went from a crude procedure involving thorn instruments to a 20-minute operation with a 95 percent clinical success rate.
I did go “yikes” a bit at 95%, a 1 in 20 failure rate is pretty rough when its about your eyes
I waited until I was mostly blind in my left eye and the right was maybe 6-9 months behind, assuming it continued to progress consistent with the left.
Driving at night had already been out-of-the-question for a while, and soon I would be unable to work, at least without learning an entirely new physical workflow.
At that point 1/20 is great. (It all worked out very well for me.)
Reminds me of my first eye exam as a nearsighted youngster. The doctor told me to go look out the window with a pair of temporary lenses. I exclaimed to my mom that those dark splotches on hillsides were trees!
> I feel truly lucky to have been born into a time of modern medicine.
Well it really depends on how you look at it...
I would argue that the truly 'modern' aspect of cataract surgery is the IOL manufacturing and implantation image-guided systems.
I have a massive respect for Ophthalmic surgeons but worth mentioning (most) current cataract surgeries still imply:
1. A manual incision (read stabbing you with a handheld scalpel)
2. Capsulorhexis (manually open the lens capsule)
3. Using a handheld ultrasonic 'jackhammer' to destroy the old lens and quite literally suck it out, working in a foggy environment with limited depth perception in a tiny chamber right next to a thin film behind the lens.
4. Finally then implanting the new IOL lens.
So with so much of 'modern' surgery still depending on Human Perception and Human submilimiter dexterity, with surgeons who are likely doing 16 plus surgeries a day. It is truly a remarkable statistic that only 5% of Cataract surgeries suffer complications.
And if you think the odds are against surgeons in Cataract surgery wait until you read up on retinal surgery, then it really drives the point home of how insanely skilled Ophthalmic surgeons are.
Funnily, when I read up on the state of the art, I felt let down that we are apparently still far away from being able to dissolve cataracts with eye drops. I'm hoping for that when my time comes.
Unfortunate that there is so much focus on treatment of advanced symptoms. Cataracts may be caused in part by metabolic disease which can be detected and treated before cataracts develop. Kind of reminds me of how my great grandfather wouldn't pay for his children or grandchildren to go to the dentist because they would lose all their teeth by their mid twenties anyway.
People here are rightly pointing out that there's still room for improvement with this (and almost any) kind of surgery, and the article talks about the accessibility challenges of making procedures like these more widely available, but after reading up on the history of this procedure it's hard not to see modern surgical techniques as a kind of man-made miracle. Great read.
The miracle is when they put a _graduated_ lens and you get cured of cataracts and myopia in a procedure where you are awake and can perfectly ntoice how while the lens is being inserted the blinding lights on top of you become more and more defined.
It's nothing short of a man-made miracle but I have to say it's also very umconfortable and stressful for the patient.
It's here already - at least for the developed countries. It's both thanks to this multitool used to handle the surgery - destroying, removing natural lens and replacing it with an implant, and technology that allowed creating customized intraocular lenses pretty fast.
My mother had her eyes done 2 years ago with one month break between. I did set timer on second surgery and it was just 20 minutes once she was inside. The only thing we had to care about were drops administered 4 times a day before and after the procedure - for once multiple alarms on my phone were useful. And of course control visit with dressing removal that happens for every patient on second day.
In my city a duet of two doctors runs an ophthalmology clinic and seems they have some good contracts with health services because they're always busy and have shorter waiting lists than clinic at our local hospital. Both women handle a queue of about 20 people and each weekday is dedicated to a different issues, with serious surgeries reserved for weekends.
I ask one of doctors if failed cataract surgeries happen because I was concerned before the first time my mum had it. She said that these are extremely rare but if a patient needs another it happens again pretty fast. The issue might be with lens that moved inside due to e.g. patient activity shortly after the procedure.
I do remember some short documentary about probably an Indian surgeon who treated eyes of North Korean elderly people. He also visited other places around the world as sort of personal goal to give new eye care technology in places where is needed but socio-economic conditions do not allow it. I'll try to find that unless someone happen to know that man's name.
Yeah, their claim that it is the most common procedure is incorrect. There are more colonoscopies performed every year, too. I followed the citations and they are citing a 2007 paper that was meta-analysis regarding cost effectiveness of cataract surgery, so the claim gets more dubious the deeper you dig.
The article is still interesting, but they probably should have left that claim out.
And the ones that have a bad time, have a really bad time, to the point of suicide in cases. Not sure if I would risk it if I didn't have 20/15 vision tbh
I'm not certain if a 5% fail rate is good or not. Fwiw, Cleveland Clinic [0] claims "Surgery improves vision for 97% of people" and an infection rate of less than .1%.
Retinal detachment, affecting 2 in 1,000 people.
Infection, affecting fewer than 1 in 1,000 people.
This was a really interesting read, and really makes me appreciate how much medical technology has improved. I have been considering getting ICL surgery or similar for years, but the improvements are still happening and I find that I wait 5 years or so and something new is developed. At some point I will get eye surgery, but until then, I'm very happy to see that we continually improve.
One of my best friends is a corneal surgeon at a university hospital, and does cataract surgery when there are other special complications. This is in Western Europe.
He told me about a work trip to India he did and how amazed he was by the routine, efficiency and lack of waste there was over there in regular cataract surgery. Literally one doctor would handle 5x to 10x as many surgeries per day as their western counterparts. Where each surgery here requires full sterilization from scratch, there they kept their wrapping etc between surgeries, and had two beds side by side. The surgeon would do one surgery while the other patient would be changed. Then he turned around and did the next cataract surgery.
Would like to see the stats behind the 5% complication rate. My understanding was under the NHS in the UK, the major complication rate was under 1%
My private surgeon was quoting well under that. 6 weeks post op on both eyes and it’s slightly weird not needing glasses (unless I have small print in a book) as he fixed the cataracts and the astigmatism due to the more expensive than standard lens implants.
Just a pity there wasn’t a option to have HUD display built into the new lenses
Something missing from the article is the discovery of local anesthetic (cocaine) by Dr. Carl Koller an opthamologist in 1884. It must have improved the success rate tremendously.
49 comments
[ 0.24 ms ] story [ 62.2 ms ] threadOne problem at the time (at least from my understanding) was actually that some people needed a second round of surgery since people are living longer and cataracts are getting corrected earlier. Last I heard, the rate of complications for a repeat surgery is significantly higher, but I assume it is improving all the time.
A fun fact: UV protection can be put directly into the lens to protect your retinas even without sunglasses (I assume this depends on the polymer type though). Also the lenses are usually tinted a slightly yellow color since our natural lenses shift color as we age. Patients tend to find it jarring if the lens is perfectly clear.
My complications apeared 2 years after the cataract procedure but were solved through laser capsulotomy, not sure if you're referring to that. But the capsulotomy is basically trivial compared to the main procedure.
Stating the obvious here but just to remind people about basic eye anatomy....
The built-in UV protection does not remove the need to wear sunglasses.
It does not protect the cornea. Only sunglasses can do that.
Basically, certain glass will (to her) essentially fluoresce in sunlight, so to her, it looks bright, bright purple. The glass in question looks like a slight, smoky grey to me, as does the glass vase at home with the same effect. I'd have to look for the link, but essentially, the new lenses filter less UV than the natural ones, and she's got a bit of sensitivity into that range of the spectrum.
Similarly, a carved item made from yooperlite has the crystals showing orange to her in sunlight, where the rest of us need to hit it with a UV flashlight.
Yeah, funny. Light it up ! For.. reasons.. I only had one eye done for a bit and, boy, did the world look different with the old and new lens. Christmas trees, for example, either looked like lit with lemon lights or bright lights. I decided to do the other eye too and the world looks bright again... from both eyes.
I did go “yikes” a bit at 95%, a 1 in 20 failure rate is pretty rough when its about your eyes
Driving at night had already been out-of-the-question for a while, and soon I would be unable to work, at least without learning an entirely new physical workflow.
At that point 1/20 is great. (It all worked out very well for me.)
https://interlude.hk/did-johann-sebastian-bach-die-from-eye-...
I feel truly lucky to have been born into a time of modern medicine.
Well it really depends on how you look at it...
I would argue that the truly 'modern' aspect of cataract surgery is the IOL manufacturing and implantation image-guided systems.
I have a massive respect for Ophthalmic surgeons but worth mentioning (most) current cataract surgeries still imply:
1. A manual incision (read stabbing you with a handheld scalpel)
2. Capsulorhexis (manually open the lens capsule)
3. Using a handheld ultrasonic 'jackhammer' to destroy the old lens and quite literally suck it out, working in a foggy environment with limited depth perception in a tiny chamber right next to a thin film behind the lens.
4. Finally then implanting the new IOL lens.
So with so much of 'modern' surgery still depending on Human Perception and Human submilimiter dexterity, with surgeons who are likely doing 16 plus surgeries a day. It is truly a remarkable statistic that only 5% of Cataract surgeries suffer complications.
And if you think the odds are against surgeons in Cataract surgery wait until you read up on retinal surgery, then it really drives the point home of how insanely skilled Ophthalmic surgeons are.
but I think it is stalled/abandoned
It's nothing short of a man-made miracle but I have to say it's also very umconfortable and stressful for the patient.
My mother had her eyes done 2 years ago with one month break between. I did set timer on second surgery and it was just 20 minutes once she was inside. The only thing we had to care about were drops administered 4 times a day before and after the procedure - for once multiple alarms on my phone were useful. And of course control visit with dressing removal that happens for every patient on second day.
In my city a duet of two doctors runs an ophthalmology clinic and seems they have some good contracts with health services because they're always busy and have shorter waiting lists than clinic at our local hospital. Both women handle a queue of about 20 people and each weekday is dedicated to a different issues, with serious surgeries reserved for weekends.
I ask one of doctors if failed cataract surgeries happen because I was concerned before the first time my mum had it. She said that these are extremely rare but if a patient needs another it happens again pretty fast. The issue might be with lens that moved inside due to e.g. patient activity shortly after the procedure.
I do remember some short documentary about probably an Indian surgeon who treated eyes of North Korean elderly people. He also visited other places around the world as sort of personal goal to give new eye care technology in places where is needed but socio-economic conditions do not allow it. I'll try to find that unless someone happen to know that man's name.
The article is still interesting, but they probably should have left that claim out.
The exception is back surgery, and the odds get worse and worse if revisions are necessary.
I'm not certain if a 5% fail rate is good or not. Fwiw, Cleveland Clinic [0] claims "Surgery improves vision for 97% of people" and an infection rate of less than .1%.
0. https://my.clevelandclinic.org/health/treatments/21472-catar...He told me about a work trip to India he did and how amazed he was by the routine, efficiency and lack of waste there was over there in regular cataract surgery. Literally one doctor would handle 5x to 10x as many surgeries per day as their western counterparts. Where each surgery here requires full sterilization from scratch, there they kept their wrapping etc between surgeries, and had two beds side by side. The surgeon would do one surgery while the other patient would be changed. Then he turned around and did the next cataract surgery.
We have a lot of waste in our medical practices.
My private surgeon was quoting well under that. 6 weeks post op on both eyes and it’s slightly weird not needing glasses (unless I have small print in a book) as he fixed the cataracts and the astigmatism due to the more expensive than standard lens implants.
Just a pity there wasn’t a option to have HUD display built into the new lenses