By Alan D. Mendelsohn, MD, FACS
When I completed my fellowship training at Bascom Palmer Eye Institute in 1987 and began practicing ophthalmology in Hollywood July 1987, I was part of a new wave of ophthalmologists who brought the exciting technique of out-patient cataract surgery to Broward County. Our predecessors would admit patients to the hospital the night prior to surgery and keep them hospitalized for an additional night following surgery. Avoiding the hassles and expenses of hospitalization was attractive, but even more advantageous was avoiding the risks of hospital –induced infections. Out-patient cataract surgery became an almost instant success.
Outpatient Cateract Surgery
For the next decade, those of us on the “cutting edge” of cataract surgery in Hollywood were doing cataract surgery by a procedure called Extracapsular Cataract Extraction whereby we removed the nucleus of the cataract in its entirety. This necessitated that we make a large incision in the eye. The cataract was removed, followed by insertion of an intraocular lens (IOL). At the completion of surgery, five to seven sutures were required to close and secure the surgical incision. The eye was pressure patched.
For the next three weeks, we encouraged our post cataract surgery patients with the following refrain: “Do not bend, do not lift, do not exercise, do not exert.” Finally, after three weeks our patients could become “free agents” again and resumed their normal lives. We began suture removal in the office, and by the sixth post-operative week the patient received a final new eyeglass prescription. The IOLs utilized in that era provided fairly good distance vision, but eyeglasses were needed to see near and intermediate distances, with fine tuning of distance vision.
“No Stich” Cateract Surgery
While moving cataract surgery to an out-patient basis was considered revolutionary at the time, an even bigger milestone transpired with the transformation of cataract surgery in the mid to late 1990’s to a highly improved technology called Phacoemulcification (phaco). Instead of removing the cataract nucleus in its entirety, with a high-tech ultrasound we could break up the nucleus into tiny fragments and suck them out. This paved the way to tiny incisions in the eye and the advent of “no stitch” cataract surgery. Phaco brought quicker, safer, and better visual outcomes to the cataract surgery arena. With great pleasure, on the very first post-operative day, I was now able to encouragingly tell my patients, “You can now bend, lift, exercise and resume 100% of your activities!” Even more importantly, post-operative edema, infections, and inflammations plummeted with the new technology. Cataract surgeries were now routinely scheduled two weeks apart instead of two months apart.
Concurrently, there have been remarkable enhancements in the instruments that we utilize pre-operatively in the office to ascertain the optimal custom fit intraocular lens for any given patient. The quality of these high tech ophthalmic devices and ultrasounds utilized pre-operatively for Iens determinations, as well as the expertise of the staff actually making the measurements, are of paramount importance for excellent visual outcomes.
From the onset of my career in 1987, through to the present time, we have been blessed with newer generations of intraocular lenses (IOLs) which provide superior vision. Another career milestone occurred within the past ten years with the arrival of the multifocal ReStor IOL. With the ReStor IOL, we can generally correct most patients’ cataracts and enable them to see near, far, and everywhere in between without the aid of glasses or contact lenses. The ability to read, drive, work on the computer, and see without glasses is an incredible freedom that was never possible with traditional monofocal lenses.
My journey in the world of cataract surgery in Hollywood has now hit three decades as I had my 30-year anniversary of practicing ophthalmology on July 1st! Perhaps the most incredible landmark and noteworthy step on this journey has been the landmark transformation in cataract surgery to the new era of laser-assisted cataract surgery that has commenced in earnest in the past five years. Femtosecond laser cataract surgery is highly reproducible, far more accurate, and far safer than older techniques of cataract surgery with a scalpel. The laser offers excellent precision thereby producing the absolute best visual outcomes in current cataract surgery. Furthermore, patients with low or moderate levels of astigmatism can have this astigmatism eliminated or greatly reduced at the same time as the cataract procedure, resulting in a markedly enhanced quality of vision and overall outcome. In essence, this is customized laser cataract surgery utilizing high-tech 3D imaging and tailoring the ultra-precise treatment to the unique size and shape of your eye.
My Own Cataract Surgery
On a personal note, even though I am a cataract surgeon, naturally I am not exempt from developing cataracts myself. In fact, in 2014, at age 56, I began to notice the litany of complaints that I have heard from my patients. First, I noticed that while driving at night, I was not as comfortable or confident as I was driving during the day. Second, oncoming headlights became bothersome, and eventually so did the rising or setting sunlight in my face while driving. Third, I had always been an avid reader, able to read small print journals or novels for hours at a time prior to the inception of my cataracts. But in 2013 and 2014, I noted that reading tiny print became more of a chore and challenge, curtailing my reading duration. Finally, and most importantly by far, I needed to be positive that my vision was excellent to examine my patients and perform surgical procedures. I decided that it was time to proceed.
In July 2014, I was the personal beneficiary of the wonderful transformations of modern ophthalmology that I described. I had advanced laser cataract surgery with the insertion of an ReStor lens in my right eye, with the same procedures to my left eye the following week. My vision is now phenomenal! I wore eyeglasses starting at six years of age and then began with contact lenses around age 13. Until age 56, I needed glasses or contact lenses for everything! Now, for the past three years, I wear no glasses, no contact lenses, nothing. Of course, I practice what I preach and always wear sunglasses with UV400 blocker and polarization outdoors during daylight hours for ocular protection. My quality of vision and depth perception are the absolute best of my entire adult life. I am delighted! Now at age 59 and feeling like the bionic man, I look forward to my next decade serving the community as an ophthalmologist on this thoroughly enlightening journey!