Guest Editorial

Cataract surgery is in a Golden Age

If you had told me 20 years ago that I would enjoy doing the same surgery over and over again, tens of thousands of times, I would not have believed you. Yet here I am, writing an editorial after spending the entire day operating — and I can unequivocally state that I absolutely love doing cataract surgery and look forward to doing so the rest of my career.

Our field has evolved so much that the way we do surgery now is certainly different from how we did it just a few years ago. Procedures have become shorter, the safety level has become higher, and the visual outcomes have become better. It’s a combination of new technologies, refined techniques and the quest for perfect vision that is driving this change.


Surgical efficiency also has improved, with most cataract extractions performed in outpatient surgery centers with just a minimal degree of systemic anesthetics. Using topical anesthesia instead of a block is the trend and some are even ditching the IV for sublingual administration of sedation. Many surgeons are doing a dozen or more surgeries in a morning, and some do multiples more. The timing of this efficiency advancement is perfect: With about 500 new ophthalmologists completing training each year, not all of whom will work full time, the need will be great for each surgeon to do more cataract surgeries as our geriatric population swells.

Safety, too, has improved, with phaco platforms offering forced infusion to maintain the anterior chamber and to reduce surge. While femtosecond lasers may not increase refractive accuracy, they can help some surgeons reduce complications by delivering a capsulorhexis and divided lens nucleus prior to entering the eye. As you’ll see from our Roundtable (page 26), not all surgeons agree about the current use of femtosecond lasers, but they do agree that future accommodating IOL designs could change that.


Our most powerful refractive procedure is cataract surgery: Anything along the spectrum from high hyperopia to high myopia can be addressed, including large amounts of astigmatism. Our pre-op testing has improved with more accuracy in biometry and advances in lens calculation methods. We can now achieve 90% of eyes within 0.5 diopters of our intended target, approaching the precision of excimer laser corneal refractive surgery.

Cataract surgery is one of the most amazing procedures in all of medicine, where we can literally take a patient from 20/200 to 20/20 in minutes. With the large number of baby boomer patients starting to hit our practices, we will be busier than ever. More importantly, though, we will enjoy performing surgery and delivering great vision. It’s a great time to be an ophthalmologist. OM