Looking Back on an Innovative Year in Ophthalmology

Seven Major Advances

In 2014, ophthalmology continued to offer exciting new challenges and stimulate its subspecialists. Not only have advances been made in medical and surgical treatments for blinding eye diseases, but the field has also seen improvements in noninvasive ocular imaging. This year also marked the introduction of big data.

Although some of these new technologies may not have originated this year, their increased acceptance and use over the past 12 months has undoubtedly shaped how ophthalmologists practice now, and will continue to do so in the future. And while it's impossible to mention every practice-changing event or trend that occurred this year, we have come up with seven that we feel offer as comprehensive a view as possible, with major advances noted across multiple subspecialties.

Enhancing Cataract Surgery

Cataract surgery, considered one the most successful and cost-effective surgical procedures in the world, has made continued advances and improvements. With the increasing popularity of advanced technology intraocular lenses (IOLs), such as multifocal and torics (astigmatism-correcting), cataract surgeons continue to refine the precision of the procedure to maximize visual and refractive outcomes. Recently, two new technologies—femtosecond laser-assisted cataract surgery and intraoperative aberrometry—have emerged that aid these efforts and help cataract surgeons get the most out of premium IOLs.

Despite some controversy, femtosecond laser-assisted cataract surgery appears to represent a paradigm shift for this procedure. The laser is highly focused and creates a plasma of free electrons and ionized molecules that rapidly expand and collapse, cutting tissue at the explosion site with microcavitation bubbles, very precisely and without thermal damage.

Having been used for a decade in creating corneal flaps for laser-assisted in situ keratomileusis (LASIK) surgery, femtosecond lasers have now been adapted to cataract surgery. There are currently four lasers approved by the US Food and Drug Administration (FDA), for precise corneal incisions, corneal arcuates, capsulotomy, and cataract lens fragmentation.^[1] Even though this technology may add to the length and cost of surgery, advocates feel it represents the future of this procedure, given its possibility for significantly lowering complication rates (ie, endophthalmitis, dropped nuclei, vitreous loss, posterior capsular opacification) and further improving already successful outcomes with advanced-technology IOLs.

Intraoperative aberrometry is another evolving technology that is being used with increasing frequency to enhance refractive results with IOLs. As patients' visual expectations after cataract surgery have increased, aberrometry has helped to better achieve the desired refractive endpoint. By taking real-time intraoperative measurements during cataract extraction, aberrometry aids in reducing residual refractive error postoperatively.^[2] This is particularly helpful with advanced technology lenses and in post-LASIK surgery eyes.

Intraoperative aberrometry is performed through an aphakic intraoperative refraction (and, in some cases, a postimplantation reading) that allows the surgeon to modify the IOL power or type, measure total corneal astigmatism for toric IOL selection and real-time alignment, and customize arcuate corneal incisions if needed.

Both femtosecond laser-assisted cataract surgery and intraoperative aberrometry, along with other advances in IOLs, elevate the field of refractive cataract surgery, where complication-free surgery is sought for the patient along with a predictable, lifestyle-enhancing, refractive outcome.

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