Cataract Surgery

By Jaime Santamaria II, M.D., F.A.C.S., F.I.C.S.

If you are over sixty years old, you could very well find yourself a consumer of cataract surgery. Any consumer comes wiser, the more he knows about what he is going to purchase. It is important to note that cataract surgery has come a long way since the days of hospitalization, sand bags to immobilize the patient and large incision operations. These advancements are a great service to humanity and have been performed by ophthalmologists collaborating throughout the world.

It is a sad commentary, however, that frequently what are great advances in ophthalmology take a long time to trickle down to the average surgeon. Some surgeons who do not perform a great deal of surgery sometimes find it hard to keep up with the most recent advances, which are designed to greatly improve the visual recovery of a cataract patient.

As an example, even in this day of small incision surgery, there are still surgeons performing an operation known as "extracapsular" in which the eye is opened with a large incision, which then requires numerous sutures and weeks of healing, with resulting astigmatism and a relatively uncomfortable post-operative period.

The current and most advanced method of cataract surgery is known as "topical clear cornea." This involves making a very small incision (3mm or less), which is self-sealing not requiring a suture. The operation is done without the need of injections around the eye in order to numb the eye. The eye is made numb with just drops. The incision in this modern method is made in the outer edge of the cornea, which has no blood vessels. This, therefore, decreases the incidence of any bleeding.

This surgery can even be done without stopping important medicines prescribed for the health of the patient, such as an aspirin a day or Coumadin.

The performance of this type of modern surgery requires very significant expertise and is one that is most successful when a doctor has a great deal of experience and a large surgical volume. The ideal behind this type of surgery is to give to every patient not only improved vision, but where possible, the finest vision they have ever had in their entire lives. This involves two important modern steps.

First, the correction of pre-existing astigmatism, so that the patient will greatly reduce his need for glasses after cataract surgery. The second step is the use of a multifocal intraocular lens that would allow the patient not only to see for distance without glasses, but also for close. The eye is like a camera, and if the lens (the cataract) of the camera is removed, the camera would be out of focus unless the lens is replaced. In the eye, the cataractous lens is replaced by an intraocular lens.

Sometimes even with the reduction of astigmatism and use of a multifocal intraocular lens, a patient may still require glasses. However, by continually aiming for this goal, many patients can end up without relying on glasses. Indeed, this could be the best vision the patient ever had.

One of the most important things is the aim to decrease as much as possible any type of complication from cataract surgery. However, they tend to occur more often with inexperienced surgeons.

Once again, an educated consumer will research that his particular surgeon is not only doing the latest technology, but is doing so in such significantly large numbers that he can maintain a superb surgical expertise. Every detail in the cataract operation is important.

Dr. Santamaria, an Assistant Clinical Professor of Ophthalmology at Columbia University in New York, is the inventor of the patented PhacoGardâ„¢ blade, which facilitated sutureless cataract surgery. He is also on the surgical staff of the Wills Eye Hospital Network. He was recognized in New Jersey Monthly "Top Doctors In NJ 2001", as well as listed in the Castle Connelly Guide "How to Find the Best Doctors in New York Metro Area."

Dr. Santamaria has offices in Perth Amboy and Edison, New Jersey and can be reached at 732.826.5159.