Marking a new era of IOL placement -- and repair

2009 marks the 60th anniversary of the first successful use of an intraocular lens (IOL) implant during cataract surgery, a procedure that many have since come to consider routine -- even take for granted, says Duke ophthalmologist Alan N. Carlson, MD.

Cataract surgery is the most commonly performed surgical procedure covered by Medicare and Medicaid, with more than a million IOLs inserted annually. Carlson, known as an expert in the area of complex cataract surgery and for his work on repairing IOL problems, says patients undergoing cataract surgery understandably have high expectations.

“The advances in IOL technology and the procedure itself make cataract surgery one of the truly great advances in modern medicine,” he says. “Almost everyone has a relative or knows somebody who raves about their outcome after cataract surgery.”

As a result, some patients may develop expectations that are not realistic for their particular case.

Additionally, some patients may encounter problems during surgery. According to Duke ophthalmologist Robin Vann, MD, the IOL can be damaged during insertion, or affected by subsequent trauma or disease that can cause it to fail. In some patients, the IOL can cause side effects such as visual aberrations that can be intolerable.

Sometimes a mistake in the power of the lens sends patients back to the operating room. In other cases, the patient may not be happy with the lens itself -- most are only sharp at one particular distance -- and although the newer accommodative and multifocal lenses offer terrific advantages for patients wanting to preserve their near vision, these lenses are not for everyone. In some cases the tradeoffs are not worth the added expense or side effects.

This new technology is still evolving and Duke eye surgeons are seeing more patients desiring these lenses, but also more patients coming for second opinions regarding some of the potential side effects.

When something goes wrong during or after cataract surgery, the removal of an
IOL is not a simple procedure. “Eye surgeons are well trained at injecting lenses,”
says Vann, “but we’re not all very well trained in removing them.”

Carlson is one of only a handful of eye surgeons in the world who has removed more than 1,000 IOL implants in patients referred for a wide variety of reasons.

"Our reputation continues to grow,” Carlson says. "Patients have high expectations and are willing to travel longer distances. Referring doctors also appreciate our willingness to work closely with them as well as their patients toward an end result that delivers the best vision and ideally meets the expectations they had going into cataract surgery."