The future of cataract surgery

As the most common procedure performed by the ophthalmic surgeon, in 2014, 4.3 million cataract operations took place in the European Union Member States. It is estimated that more than 23 million procedures will be performed worldwide in 2016.^1,2

Meanwhile, during the past 35 years, life expectancy has increased by 12 years in Western countries and by more than 25 years in most developing countries.^3,4 Since we know that the occurrence of cataract increases with age; that the prevalence of cataract is greater in developing countries; and that more than 70% of people aged older than 85 years are affected⁵, the medical community faces the threat of insufficient numbers of ophthalmic surgeons.

In the United States, some 9,000 ophthalmic surgeons were performing 3.6 million cataract surgeries in 2015.² This means that in 5 years’ time, 125,000 surgeons will be required to treat 50 million cataracts per year. In 10 years from now, the number of surgeons needed worldwide could soar to 250,000.

Faced with such numbers, robots and technicians will have to take over. Cataract surgery only recently became more automated, the femtosecond laser having taken over part of the job since 2013. Femtosecond laser-assisted cataract surgery will continue to grow in popularity and the recently introduced nanolaser photo-fragmentation takes over another significant part of the surgery. The insertion of a preloaded IOL by a technician or a robot might be a future development.

Beside robotics, technology will evolve to enable successful cataract procedures in both eyes during a single session, thus saving time. Immediately sequential bilateral cataract surgery will become the norm.

Techniques will also evolve so that treatment of both eyes on patients sitting in the upright position, as happens today in the dentist’s chair, will be possible.

Further advancements could be that dilation of the pupil, an inconvenience that incapacitates patients for half a day, might no longer be necessary, and IOL power calculations might be made in the operating room on the day of surgery using ray-tracing techniques. Using three-dimensional technology, a preloaded IOL would be printed in the surgery room and personalised (unifocal-, bifocal- or accommodative) for each patient.

Also in the future, human intelligence is likely to find a way around the need to use an eye speculum for cataract surgery. Unmodified for more than 100 years since it was developed by Arruga and Barraquer, it is (probably) sometimes responsible for the only annoying sensation experienced by a patient during the procedure.

Finally, alternative potential strategies involving genetics are being explored for the prevention of cataracts that could lead to the end of cataract surgery.^6.7

In summary, implementation of these steps could provide an answer to the overwhelming increase of cataracts requiring treatment worldwide. It will be interesting to review things again in 10 years’ time!

References

1. Eurostat. http://ec.europa.eu/eurostat/statistics-explained/index.php/Surgical_operations_and_procedures_statistics

2. Lindstrom R. Thoughts on cataract surgery. Review of Ophthalmology. 9 March 2015.

3. The World Bank. http://data.worldbank.org/indicator/SP.DYN.LE00.IN

4. Eurostat. http://ec.europa.eu/eurostat/statistics-explained/index.php/File:Life_expectancy_at_bi 26/12/2016

5. Cataract Epidemiology: http://www.news-medical.net/health/Cataract-Epidemiology.aspx

6. Zhao L, et al.Nature. 2015;523:606-611

7. Mahesh Shanmugam P, et al. Indian J Ophthalmol. 2015;63:888-890

E: frank@goes.be

Dr Goes is medical director, Goes Eye Centre Left Bank in Antwerp, Belgium.

Dr Goes serves as a member of the Ophthalmology Times Europe Editorial Advisory Board. He did not indicate any proprietary interest relevant to the subject matter.