Vision quest

Chicago-Developments in techniques and technology are enabling the quest for the perfect cataract operation. However, as surgeons move toward this goal over the next decade, they will face a number of social, socioeconomic, and financial issues.

"Dr. Kelman wrote: 'It becomes a matter of selecting the possible impossible dream . . . evaluating your own aspirations, not setting them too low, but rather too high, just a little too high,' " quoted Dr. Koch, Professor and The Allen, Mosbacher, and Law Chair in Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston.

Dr. Koch discussed the quest for the perfect cataract operation by presenting an "incomplete" list of predictions for the next decade.

"For example, with the femtosecond laser surgeons can create a perfect capsulorhexis every time, but we really don't know what that should be," he said. "It is also to be determined whether surgeons can afford the extra time, cost, and [staff] needed initially to implement the new technology, how it will influence the role of technicians in surgery, and how will surgeons be able to provide the femtosecond laser procedures widely to their patients."

"Surgeons will need to be skilled to use new IOLs and perform new procedures, including those needed to handle associated complications and for removing IOLs as better alternatives emerge," he said. "We will need better understanding of the optics and vision of the eye and of the impact of our procedures on vision and measures of quality of vision as well as skills and knowledge to address potential problems of reduced contrast sensitivity and to enhance corneal and IOL optics."