Mary Savoie was perfectly prepared for the surgery on her cataracts, which were interfering with many of her favorite activities. At 80, she represents the one in every two people her age whose vision has become so limited by the yellowing lenses in the eyes that surgery is needed to regain a full and active life. Savoie's vision was so impaired by her cataracts that she had stopped driving at night. "I might not have had any place to go, but it made me feel trapped," she said. An avid reader, she'd begun to struggle with the words on the page. And the stress of playing bridge, another of her favorite pursuits, made her eyes feel dry. When she came to see her eye doctor at the Byers Eye Institute in Palo Alto this spring, she was ready for the procedure, even though a patient education video had left her a bit frightened.
Now, Savoie is the first patient at Byers—and one of the very first in California—to have a cataract removed with the help of a laser her eye surgeon describes as "one of the most amazing things to come along in cataract surgery." Savoie's vision is so improved that she says she was a child when she last saw the sky so blue. "I can't tell you how wonderful I feel," she said. And because she had one cataract removed with the laser and the other by the traditional approach, her experience gives her a special perspective.
Each year, 3 million Americans have their cataracts removed and the approach has not varied for years: With hands trained by years of careful practice, ophthalmic surgeons follow the circular outline of the eye's lens to reach the tissue hardened by time and score its surface with ultrasound so it can be removed and then replaced with an artificial lens.
The advantages of the laser begin with its predictable precision. "Creating a circular opening in the lens capsule is a critical step in cataract surgery," said Artis Montague, MD, director of cataract surgery services at Stanford and director of the operating rooms at the Byers Eye Institute. "Experienced surgeons are quite good at creating these circles. I've drawn thousands of them, and can create that circular opening very well, but compare me making that circle to a laser making that circle and the laser is going to be perfect every time."
That perfection, guided by a three-dimensional scan of each patient's eye, is just the first step. Because the laser breaks up the cataract into a latticework field of tiny squares, the surgeon then can remove the cloudy lens with far less ultrasound energy. The difference in impact and inflammation is substantial, compared to the traditional surgery. Nearly a month after the traditional surgery on her left eye, Savoie still feels the grittiness that patients typically experience. In her right eye, done with the aid of the laser, she feels nothing at all except for that dramatic improvement in vision.
Montague, who said she is traditionally conservative by nature and cautious to adopt new things, has been persuaded by Catalys' innovative technology, based on the ideas of Stanford clinicians and researchers. "Patients are happier and that's why I went into medicine—to help patients, so for me it's very satisfying. It feels so much safer. Time will tell, but I think it has the potential to change cataract surgery tremendously."
Laser technology has been used for decades to reshape the cornea as a way of correcting nearsightedness, farsightedness and astigmatisms. The challenge of using it in cataract surgery was to control its intensity to avoid collateral damage to surrounding tissue, the retina and other parts of the eye, yet still to power the precise incision required for the cataract removal. The technology, known as the Catalys, uses a non-invasive imaging technique to create a three-dimensional, computerized map of the eye that forms the basis for an ideal pattern for the laser to follow. That pattern is then superimposed on the three-dimensional image of the patient's eye to confirm for the surgeon that the laser is on target. It also allows the surgeon to monitor the laser's incisions.
The reduced energy needed to remove the lens also reduces the risk of infection, damage to surrounding tissue, including the corneal epithelium, and other complications. Nearly 60 years ago, Savoie's mother had cataracts removed from both her eyes. "She was a week in the hospital with sandbags on each side of her head the whole time," Savoie said. "When I think about that, I think how amazed she would be now."