It is possible to see the innovation in cataract surgery as a long tradition of artistic creativity, even countercultural. In several situations, this creative process faces the resistance of the developed authorities before it is possible to show the importance of a new concept in order to enhance current procedures. Since the advent of the basic components of modern cataract surgery, a multitude of gradual advances has resulted in what is certainly the world’s easiest, safest, and most effective surgical technique today. These advances include reducing the incision-related size and therefore morbidity, the lens extraction efficiency by minimizing the energy needed to break up and evacuate the lens, and improving the precision of measurements of intraocular lens strength to refine postoperative refractive results.

Capsulorhexis

For cataract surgery, capsulorhexis is the starting point. Various instruments and tearing patterns were used in early methods. The femtosecond laser has entered the arena since that time, promising for any operation a well-centered perfect capsulotomy. Femtosecond lasers, however, are very costly. The quest for cost-sensitive solutions has stimulated a range of interesting alternatives to be created. The CAPSULaser (Excel-Lens), one of these, earned the CE label in 2017. It is a thermal laser to which a normal operating microscope is mounted. The Zepto accuracy pulse capsulotomy device (Mynosys) has obtained the CE mark and US FDA 510K approval as another alternative. To produce circular capsulotomies, the device uses a disposable handpiece, microsecond electrical pulses, and suction.

Innovative IOLS

With an unparalleled number of new concepts, IOL developers are responding to the remaining challenges of cataract surgery. The quest for better multifocal IOLs is motivated by the need to reduce the nagging problems with glare, halo, and patient frustration associated with the first generation of this class of lens. The FineVision (PhysIOL), the AcrySof IQ PanOptix, and the Zeiss AT LISA are now gaining ground among Trifocal IOLs. Another important development in the multifocal IOL sector is an extended depth of focus (EDOF) lenses. Tecnis Symfony (J&J Vision) was the first to be sold, and AT LARA (Zeiss) was also recently introduced on the market. More recently, monofocal IOLs have appeared on the market based on the pinhole concept to improve focus depth. This involves an IC-8 IOL (AcuFocus), a single-piece monofocal hydrophobic IOL, and an acrylic, small-aperture sulcus IOL, the XtraFocus pinhole implant (Morcher).

Accommodating IOLS

Thanks to some groundbreaking products now in clinical trials, the idea of a genuinely welcoming IOL is moving closer to the truth. By increasing and decreasing the amount of fluid inside the optic, the FluidVision (PowerVision) modifies accommodative control. The Juvene (LensGen) is a modular two-lens IOL made of a monofocal base lens into which a curvature-changing fluid-optic accommodating part is mounted. The Sapphire IOL (Elenza), an electronically controlled, remotely programmable, customizable IOL, is another novel lens in progress. Also in progress are Sulcus-implanted accommodative IOLs.

In our understanding of cataract surgery, clinical research has also made major developments. Confirmation of the significant reduction of intraocular pressure in patients with mild to moderate glaucoma from cataract surgery alone is one of the most critical outcomes of recent studies of minimally invasive glaucoma surgery. Randomized, randomized clinical trials that offer the highest level of proof for this phenomenon have now shown some clinically relevant decreases in IOP in glaucoma patients undergoing cataract surgery alone. Nevertheless, as global demographics expect a growing appetite for cataract surgery, challenges remain to provoke the creativity of scientists and entrepreneurs.

innovation in cataract surgery