The Cutting Edge of Cataract Surgery: Leveraging New Technologies

Dr. Kendrick M. Wang, an ophthalmologist at Berkeley Eye Center in Houston, Texas, specializes in cataract, refractive, and glaucoma surgery. He earned his medical degree from Johns Hopkins University and completed his residency in ophthalmology at Yale University. Following his residency, Dr. Wang pursued advanced training through an anterior segment fellowship at Berkeley Eye Center, further honing his expertise in complex eye surgeries.

Modern cataract surgery is no longer just about restoring lost vision—it is about leveraging novel technologies to do more. Patients today expect more than simple clarity; they want freedom from glasses and visual outcomes tailored to their lifestyles, whether for reading, working, or driving. Breakthroughs in intraocular lens (IOL) technology have made these aspirations a reality. This refractive mindset transforms cataract surgery into a life-enhancing procedure, providing customized solutions to meet patients’ goals and lifestyles. At the same time, innovative approaches such as microinvasive glaucoma surgery and sustained-release medications enable us to address other ocular conditions, such as glaucoma, during the same procedure. These advancements reduce the burden of disease and improve overall eye health. To deliver the highest level of care, today’s cataract surgeon must remain current with these innovations, ensuring patients benefit from the full spectrum of modern surgical options.

Selecting the right IOL requires understanding each patient’s activities, preferences, and ocular health to align their expectations with realistic outcomes. Diffractive multifocal IOLs remain popular for providing a full range of vision, from near to far. Alcon’s PanOptix has been a mainstay, while Johnson & Johnson’s new Odyssey multifocal improves upon its predecessor, Synergy, with a broader landing zone and fewer dysphotopsias. Bausch & Lomb recently introduced the Envy IOL, which focuses on minimizing visual dysphotopsia. However, caution is needed when considering multifocal IOLs for patients with conditions like macular degeneration, epiretinal membranes, or glaucoma, as these pathologies can limit lens performance and patient satisfaction.

Extended depth-of-focus (EDOF) IOLs, such as Alcon’s Vivity, offer an excellent alternative for eyes with only mild pathology or for patients who are concerned about halos or glare. However, patients with EDOF IOLs may need to employ a monovision strategy or still require glasses for certain distances.

The Light-Adjustable Lens (LAL) by RxSight is the first and only IOL that allows postoperative customization using UV light adjustments. It is particularly useful in post-refractive eyes, such as those treated with LASIK, PRK, or RK. The LAL Plus offers a small continuous increase in central lens power to provide additional depth of field but should be used cautiously in post-refractive eyes or eyes with pathology.

Other niche lenses, such as Bausch & Lomb’s IC8 Apthera IOL, help address irregular corneas and provide some range of vision but require careful patient selection due to dimming effects. Additionally, the ClearView 3 segmented bifocal IOL by LensTec reduces halos and is a useful tool in specific cases.

Cataract surgery alone often reduces intraocular pressure, benefiting patients with glaucoma. However, the interventional glaucoma mindset takes this further, shifting the paradigm from reliance on topical therapies and invasive surgeries to earlier procedural interventions. These approaches reduce disease progression and improve long-term outcomes.

Minimally invasive glaucoma surgery (MIGS) tools have revolutionized this approach. Devices such as the iStent (Glaukos) and Hydrus (Alcon) bypass the trabecular meshwork, enhancing aqueous outflow through the eye’s natural drainage pathways. Complementary technologies like iTrack (Nova Eye Medical), Omni (Sight Sciences), and Streamline (New World Medical) facilitate viscocanaloplasty, either independently or in combination with trabecular bypass stents, to further optimize aqueous outflow. In more advanced glaucoma cases, goniotomy remains an effective option, providing additional intraocular pressure reduction when necessary.

These MIGS devices seamlessly integrate into cataract surgery, offering a safe and minimally invasive way to enhance intraocular pressure control while reducing reliance on drops and avoiding the risks of traditional filtration surgeries.

Procedural pharmaceutical innovations, such as the iDose implant by Glaukos, further expand the toolkit. Eye drops have significant downsides: cost, compliance challenges, ocular surface irritation, and allergies. By delivering sustained-release medication directly into the eye, iDose can be implanted during cataract surgery, reducing or eliminating the need for drops. These sustained-release solutions offer a consistent and effective approach to pressure control, alleviating the burdens associated with traditional therapies.

A new era in cataract surgery has arrived, one that empowers surgeons to adopt both a refractive mindset and an interventional glaucoma approach. By staying at the forefront of innovation, we can redefine patient care, meeting and exceeding expectations with comprehensive solutions that address both visual and ocular health needs. As these technologies evolve, they challenge us to view cataract surgery not merely as a means to restore vision but as a transformative opportunity to enhance both vision and quality of life.