PERSONAL HEALTH : Technology Speeds Eye Surgery Healing
This year, 1.2 million Americans will undergo surgery for cataracts. And patients today can anticipate a much speedier recovery and better results than in years past, thanks to improved technology and techniques.
Most will be able to do without the thick eyeglasses once commonly needed after surgery. Instead, they will rely on implanted artificial lenses and routine spectacles.
“A decade ago, the average patient went to the hospital the night before surgery and went home one to three days later,” notes Samuel Masket, an associate clinical professor of ophthalmology at UCLA’s Jules Stein Eye Institute and a West Hills ophthalmologist who specializes in cataracts.
In years past, a patient with cataracts--which cloud the eye’s lens--would have unstable vision for six weeks or more after surgery. This was largely because of surgery-induced astigmatism--an irregularly shaped cornea that results in blurred vision. Once the vision stabilized, Masket says, the patient could be fitted with spectacles or the sutures could be cut to eliminate the blurriness. If surgery was needed on both eyes, a two-month interval between operations was typical.
“Today, a patient usually goes to an ambulatory surgery center and returns home a half-hour or an hour after surgery,” Masket says. Within days, vision usually stabilizes. Intervals of a month or less between surgeries are common.
What’s made the difference?
* The size of the incision made to remove the natural lens has decreased dramatically, says Masket. It is often one-fourth the size of past incisions.
* A special type of incision can minimize the chance that astigmatism will develop or worsen after surgery.
* Instruments have been improved. In traditional cataract surgery, the cloudy lens was removed in one piece. Now, surgeons use a technique called phacoemulsification, whereby a high-speed needle breaks the lens into particles that can be suctioned out. * Artificial lenses have improved.
With the foldable lenses in place, most patients have good distance vision but need spectacles for close work. In the future, some cataract patients may be able to forgo eyeglasses altogether.
TWO VIEWS
‘Sander’ Can Reopen Blocked Blood Vessels
For several years, a technique called balloon angioplasty has helped patients with clogged coronary blood vessels avoid surgery. The procedure involves inserting a balloon catheter into the clogged vessel and inflating it to reopen the vessel.
Now, a device called a Rotablator is under investigation for treatment of coronary blockages at 14 clinical sites nationwide. The tiny device, with a tip spinning at 190,000 r.p.m., “sands down” the blood vessel deposits, which are carried away through the bloodstream. What role might this tiny “sander” play in treatment of heart disease patients?
Tim Fischell, cardiologist and assistant professor of medicine, Stanford University
“It will not replace the balloon as a mainstay for treatment of cardiovascular blockage. The primary indication is for patients with heavily calcified blockage so hard that balloons might not crack it open. It works less well on softer blockages.
“In terms of safety, it is best for blockages that are not very long. There is a tendency for diabetics to tolerate the device less well. It doesn’t remove the plaque from the body. Most particles are small enough to be carried away by the bloodstream without causing damage.”
Robert Ginsburg, professor of medicine, director of the Unit for Cardiovascular Interventions, University of Colorado, Denver
“It will complement the balloon technology. The balloon is the workhorse. The Rotablator is very good for calcified, diffuse lesions.
“Its mechanism, sanding, doesn’t tear the vessel, so it may reduce complications. It can be used in diabetics, but with caution.
“It’s not meant for use during an acute heart attack. We have never seen a major heart attack after its use. Because of the possibility, we limit the area worked on at any one time.”
SHOPTALK
Patch Puts an End to Kids’ Warts
Anew wart remover specially designed for children is available over the counter. Called PediaPatch Wart Remover System for Children, each patch contains salicylic acid, a drug commonly used to treat warts and other skin disorders. The child wears one to bed each night. Usually the wart is gone within a few weeks, according to the manufacturer.
For information, call (800) 345-8084.
