Have there been any recent advances in cataract surgery?

DEAR DOCTOR K:

My husband had cataract surgery 10 years ago. Now it’s my turn. Have there been any advances in the past decade that I should know about?

DEAR READER:

A cataract is a clouding of the lens of the eye. It commonly causes poor vision and blindness among older adults. But cataracts can be surgically removed and replaced with artificial lenses. In fact, cataract surgery has become fairly routine. The vast majority of people who undergo this procedure have excellent outcomes.

I spoke to my colleague Dr. Christian Song. He is a cataract and refractive surgeon at Harvard-affiliated Massachusetts Eye and Ear Infirmary. He noted that advances in imaging and measuring, and of the lenses themselves, are making cataract surgery even better.

Typically, cataract surgery is an outpatient procedure. To remove the cataract, the surgeon makes a circular incision around the eye’s lens. Then he or she uses ultrasound to break up and remove the cloudy lens. After that, a new lens is slipped into the eye.

Some surgeons still use a scalpel for the incision. But more and more, surgeons are using an ultra-short-pulse laser. This allows doctors to make more precise incisions than they can by hand, and softens the cataract for easier removal. The laser also helps to ensure better centering of the implanted lens. Another advance: These days, 3D imaging is used with the laser, allowing still greater precision.

Once the cataract has been removed, a device attached to a microscope measures the total refractive error of the eye. (A refractive error occurs when the shape of the eye prevents light from focusing directly on the retina. As a result, vision appears blurred.) A sophisticated new technology called “intraoperative wavefront aberrometry” allows doctors to more accurately calculate the right lens power for the eye. This has been especially helpful for people who have had previous laser vision correction, such as LASIK.

This technology has also improved the ability to reduce or eliminate the effect of astigmatism. This is an imperfection in the shape of the cornea or lens, causing images to appear distorted or blurry.

Despite these advances, cataract surgery is not without risks. Complications are rare, but they can include severe vision loss, bleeding and infection.

That may sound scary, but the important thing to remember about rare complications is that they’re rare. I’m not being flip; I’m having cataract surgery in a few weeks, well aware of the possible complications. But I’ve balanced the benefit from the surgery against the risk — and it’s an easy call for me.

Cataract surgery won’t necessarily give you the vision you had when you were much younger. I’m not expecting that, and neither should you. But it is very likely to improve the vision you and I have now.

Cataract surgery today is so much more successful, and complications are so much rarer, than when I went to medical school. You and I can look forward to a very good outcome.