New lens implant adds twist to cataract surgery business

Author: AP
Darlene Seltmann / USAF

OMAHA, Neb. (AP) – Cheryl Henry remembers putting on her first pair of glasses in second grade and getting a whole new view of her family’s Iowa farm.

“Mom,” she recalls saying, “did you know you can see to the end of the driveway?”

She switched to contact lenses as a high school freshman – she was a volleyball player – and had worn them ever since.

Recently, however, Henry, 63, threw out her contact lens solution.

She’d developed the beginnings of cataracts, so she scheduled the first of two cataract surgeries to replace her clouding lenses. On Sept. 1, the retired teacher became the first person in Nebraska to receive a new type of lens implant that offers a greater depth of focus than other available lens implants – improving vision at near, medium and far distances. It also reduces patients’ reliance on glasses after surgery.

“To be able to have nothing,” Henry said of life without glasses or contacts, “it’s exciting.”

Dr. Lance Kugler, the Omaha ophthalmologist who performed the procedure, said the Tecnis Symfony Intraocular Lens allows doctors to offer advanced lenses to a wider range of patients, some of whom couldn’t have them before.

But even more important, he said, the lens’ arrival highlights a string of advances that have helped bring cataract surgery into the modern age.

“Cataract surgery today is not your father’s cataract surgery,” said Kugler, who specializes in refractive surgery at his west Omaha practice.

The vast majority of patients receiving lens implants still are treating cataracts. In terms of sheer numbers, cataract surgery is the most common surgical procedure in the United States. Everyone develops cataracts eventually, if they live long enough. By age 80, more than half of Americans either have cataracts or have had cataract surgery.

But Kugler and other ophthalmologists said a growing number of people are getting lens implants before they develop cataracts, replacing natural lenses that have lost their ability to change shape and shift from near to far with age, a condition called presbyopia. Kugler said lens replacement is the fastest-growing segment of his practice.

Dr. Brent Timperly, an assistant professor at the University of Nebraska Medical Center’s Truhlsen Eye Institute, said lens implants may be a good option for older people who are presbyopic and have lost near vision. Although any surgery comes with risks, cataract surgery is a relatively low-risk procedure.

“It is a coming thing for baby boomers,” he said.

Dr. Michael Feilmeier, an ophthalmologist at Midwest Eye Care in Omaha, agreed that pre-cataract lens implants are a reasonable option for some patients, particularly those who aren’t candidates for the cornea-correcting Lasik and those who are over 50.

But surgeons need to make sure patients understand that there is some risk, said Feilmeier, president of the Nebraska Academy of Eye Physicians and Surgeons. For men under 50 in particular, cataract surgery comes with a risk of retinal tear or detachment, said Feilmeier, who serves on a national cataract curriculum committee for the American Academy of Ophthalmologists.

Kugler said it’s important to choose the right procedure for each patient based on individual eye conditions and what patient wants from the procedure. If patients have risk factors, he sends them to a retina specialist for an evaluation before surgery.

The recent advances are exciting because they offer more options. “It’s not a miracle cure,” he said. “It’s not for everybody. Patient selection is key.”

The Omaha World-HeraldĀ reported that doctors started to replace natural lenses with artificial lenses in the mid-1970s. Those lenses, known as monofocal lenses because they focus at one point, work well for distance vision, but wearers typically still need reading glasses or bifocals to see clearly up close.

Dr. Guy Kezirian, a Scottsdale, Arizona, ophthalmologist and pioneer in the field, got lens implants a month ago. At 57, he’d become farsighted and had lost or broken a lot of glasses. He chose a monofocal lens because they perform better in low light, which he works in a lot.

“The job of the surgeon is to help match the right patient to the right technology,” he said.

Multifocal lens implants came along about a decade ago. They focus light at different distances, functioning more like bifocal glasses. But those with astigmatism – corneas that don’t focus well because they’re more football-shaped than round – couldn’t use them. Some users had side effects, seeing rings or halos around headlights or streetlights at night. About the same time, manufactures produced a lens that could fix astigmatism. It improved distance vision, but users still needed reading glasses.

“Everyone had some compromise,” said Kugler, who heads a committee working on clinical guidelines with the Refractive Surgery Alliance.

The Symfony, made by Abbott Medical Optics and approved by the Food and Drug Administration in July, uses a different type of technology. Rather than splitting light into near and distant focal points, the layered rings in the lens extend the depth of focus. The lenses also can be used in people with eye problems, including mild macular degeneration, that rule out traditional multifocal lenses. And it comes in a version that fixes astigmatism.

Most cataract surgeries are done manually, a safe and accurate procedure. Kugler and others also have begun using the femtosecond laser, which was introduced in the United States in 2011.

Kugler said the laser allows him to correct astigmatism at the same time he’s implanting lenses, and the laser’s consistency and precision allow him to collect data to improve outcomes.

Before her procedure at the Miracle Hills Surgery Center, Henry’s right eye was dilated and numbed. She received just enough IV anesthetic to relax her, then lay in a reclining chair. Kugler used the laser to soften her lens, which is inside the eye, and to make two tiny incisions in the cornea to treat her astigmatism. Time elapsed: two minutes, nine seconds. Then Henry moved on to an operating room, where Kugler extracted her lens through a tiny slit and inserted the new lens, which is about the size of a pencil eraser tip and has two tiny arms to secure it in the eye.

Back in a recovery area, Henry said she could see the face of a person across the room, something she couldn’t have done before without glasses. At a follow-up appointment, both her near and distance vision were 20/20. She had her left eye treated Sept. 15. Two other ophthalmologists who operate at the Miracle Hills center, Dr. Matthew Brumm and Dr. Carol Drake, also implanted their first Symfony lenses this month.

Henry can now wake up and see her alarm clock without glasses. “It really is amazing to get up and be able to see,” Henry said.

Henry’s results are in line with those in a clinical trial of the Symfony lens. Dr. Jason Jones, a Sioux City ophthalmologist who participated in the trial, summarized the results in a recent journal article. In the randomized trial, 148 people received the Symfony lens in both eyes and 150 got monofocal lenses. Distance vision for the two groups was comparable, but intermediate and near vision without glasses was significantly better in the Symfony group.

The Symfony group also wore glasses less. Eighty-five percent of Symfony users reported wearing glasses “none” or “a little bit” of the time. The majority – 63 percent – said they never wore glasses, nearly twice as many as the control group. Most – 90 percent or more – reported mild or no halos, glare or starbursts.

The advanced lenses and lasers do come with more out-of-pocket costs than a traditional cataract surgery. Insurance and Medicare cover what’s needed to fix a patient’s cataracts, Kugler said. But neither covers the cost of laser corrections or advanced lens technology. Patients pay those costs, which can range from $2,000 to $6,000 an eye.

But Kugler said the costs generally are thousands less than the cumulative costs of glasses, contacts and solutions. And having corrected vision frees people to do what they want to do, whether it’s pursuing an active lifestyle or being able to see cellphone screens, car navigation systems or the sports ticker at the bottom of the TV without stopping to put on glasses.

“The quality of life,” Kugler said, “it’s pretty hard to put a price on it.”

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