The introduction of phaco in 1967 was a defining shift in the treatment of cataracts, glaucoma, and complex infant eyes, as well as expansion in the provision of global eye care into the future.
“I originally trained in the 1970s. With intracapsular, and later, extracapsular surgery, your control of IOP usually was worse,” said Alan S. Crandall, MD, professor and director of Glaucoma and Cataracts, Moran Eye Center, University of Utah School of Medicine, Salt Lake City.
“With phaco, you suddenly have a three- to five-point drop in IOP after cataract surgery,” Dr. Crandall added. “That unexpected collision between phaco and glaucoma sparked a blossoming of technology that has brought us to micro-invasive glaucoma surgery (MIGS) devices and similarly, important innovations in low-tech treatments that are improving eye care around the world.”
Marriage of treatments
The continuing development of phaco created a new category of combined cataract and glaucoma surgery that has become one of the most common ophthalmic surgical procedures in the developed world, Dr. Crandall said.
Intracapsular gave way to extracapsular procedures, but there was little innovation until the often contentious adoption of phaco, he noted.
“There is a clear progression from intracapsular to extracapsular to phaco to small incisions to small implants,” he said.
“The 1980s and 1990s were an exciting time in cataract surgery,” Dr. Crandall said. “But glaucoma surgery was pretty much trabeculectomy; there were some minor adjustments—mitomycin C here, selective laser trabeculoplasty there.”
It would take another decade for advances in cataract to move into glaucoma with successive generations of ever-smaller, ever less-invasive devices, he noted.
Learning from the unexpected lesson that phaco lowers IOP, generations of researchers have been searching for technologies and techniques that can be translated from one disease or treatment area to another.