Times—they are a changing. Look mom, no hands! Look, no wires! No ethernet connection necessary. No phone cord needed. No wires. No need to remove the corneal flap. No key to open my door. No reason to remove the whole capsule. No reason to actually even use drops for cataract surgery. Driverless cars. Pilotless planes. No sugar in my soda. No meat in my burger. Wait, back up. No drops for cataract surgery? What you talkin’ ‘bout, Willis?
Changing landscape for ODs
Cataract surgery has entered that technology zone enabling surgeons the opportunity to provide sutureless and bladeless surgery, in vivo axis orientation and aberrometry measurements, and now, remove the drops from this pervasive procedure. The advent of technology creates a changing landscape for the optometrist who is following his patients after surgery.
I remember a time when I saw a perfectly round anterior capsulotomy performed by the femtosecond. I was astounded and marveled at the precision of the cut.
However, the capsule was adhering to the endothelial cells of the patient’s eye.
This particular patient was seeing 20/15 and had absolutely no visual problems, yet the optometrist who was following this patient had some concerns. The capsule eventually folded on itself and left a triangular flap of tissue on the superior corneal endothelium.
The call I got sounded like this: “Dude, I think the cornea is breaking up from in the inside. The patient is only visiting, but can you look at him before he goes blind, or worse, his insurance runs out?” Newer technology adds simplicity but also potentially adds new challenges for management, like your battery dying on your PDA. Dropless cataract surgery falls into that category—just no batteries.
1. Friling E, Lundstrom M, Stenevi U, et al. Six-year incidence of endophthalmitis after cataract surgery: Swedish national study. J Cataract Refract Surg. 2013 Jan;39(1):15-21.
2. Liegner JT. Better surgery though chemicals: topical and intracameral agents for the anterior segment surgeon. Course 27-303 presented at: The ASCRS/ASOA Symposium; April 27, 2014; Washington, DC.