Cataract Surgery Is Getting Easier On The Eyes

As I write this on my home computer, it's noon, barely two hours since I lay on an operating table at New York's Mount Sinai Hospital. While I chatted with him in a sodium-pentathol haze for 45 minutes, Dr. Julius Shulman performed some surgical procedures known by such tongue-twisting terms as phacoemulsification and intraocular implantation. That is, he removed a cataract from my right eye and inserted a new lens.

As one of more than a million people a year who have cataract surgery, at a cost that runs from $1,100 to several times that, I know I'm on my way to seeing things more clearly. After a few weeks of healing, I'll be fitted with glasses far weaker than my old ones. I'm certain my vision will sharpen because my left eye had similar surgery three years ago. And since then, says Dr. Andrew Farber, a Terre Haute (Ind.) ophthalmologist, "the technique has improved greatly." Surgeons now make much smaller incisions, speeding healing time significantly. More than 90% of patients get improved vision, without complications.

GHOSTS. Usually, advancing age causes cataracts -- a clouding or change in the eye's lens. The cloudiness may increase over months or years, but few people wait until the lens is opaque to undergo surgery. If you sometimes seem to see through a film of smog, a cataract may be developing. Or if the lens thickens slightly, as mine did, objects can appear with a "ghost," as on a TV screen.

Unlike other operations, you tell the doctor when you need surgery. Shulman says the average patient tolerates impaired vision for two or three years before agreeing that glasses or contact lenses are no longer sufficient.

Contrary to popular belief, the operation isn't done with a laser. Peering through a microscopic device, the surgeon makes a 1/4-inch incision in the cornea with a scalpel. Then an ultrasonic vibrating probe points into the opening to emulsify the cataract and suction it away. After a plastic lens -- no larger in diameter than a pencil -- is inserted, a hair-thin nylon stitch closes the incision.

Patients who wear glasses still need them afterward -- especially for reading, since the implanted lens can't flex like a natural one for close-up work. And in 30% to 60% of all cases, says Farber, a clear membrane behind the lens may itself become cloudy in a few years. Then, a laser can come into play. The surgeon can use it to burn a tiny hole in the membrane, so light can get tothe retina unimpaired.

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