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I Can See Clearly Now the Cataracts Are Gone

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Some eye surgeons who have tried lasers for cataract removal in clinical trials say the technique may also give some patients better, more stable vision after surgery than phaco because it requires only a very small surgical incision. This is therefore less likely to distort the cornea, which can result in an astigmatism that can affect the quality of vision.

But what really has laser makers salivating is the prospect that lasers could one day be used to correct vision in people who do not have cataracts. The technique would differ from current vision correction methods that require cutting into the cornea with blades or blasting away at it with lasers to change its shape and thus bring light coming into the eye into better focus.

Removing and replacing a normal natural lens with another lens of different power that corrects the vision problem, a procedure called clear lensectomy, could accomplish the same thing but leave the cornea intact.

Since cataract surgery is a very safe and extremely effective procedure -- the success rate is more than 95% -- clear lensectomy would also likely be a safe way to surgically improve vision. But clear lensectomy is not approved by the FDA, and current artificial lens designs can't replace the ability of the natural lens to accommodate for changes in gaze between near and distant objects, which is needed for activities like reading.

"Of course, the big advantage that we're all waiting for is that the small incision will lead to smaller lenses [that can be inserted through the small incision] and hopefully, eventually, to injectable lenses which could preserve accommodation," says Reinhold Thyzel, director of Laser Corp. and it's American subsidiary, A.R.C., which is developing the system designed by Dodick. Clear lensectomy and replacement with a flexible accommodative lens is an intriguing but still unproved idea, and it's not likely to become a reality any time soon, both Thyzel and Dodick acknowledge.

Other surgeons who have experience with the laser caution that it's not benign, noting that the laser works by breaking down the lens in a manner very similar to the high-energy vibration used in phaco.

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