Eye care experts in Arkansas report that even though the demand for eye surgery is increasing dramatically because of the aging population, advances in eye surgery including routine surgeries like those for removing cataracts can be done more quickly and safely. And advancements in other types of eye surgery are helping more people preserve their eye sight.

“Around the state, most of the doctors I talk to are getting pretty efficient at doing cataract surgery,” said Robert Berry MD, an ophthalmologist with Eye Care Arkansas. “The surgery is getting better and faster. Arkansas has a greater share than most other states of the 10,000 or so people who turn 65 every day in the country. It is a little older population and somewhat poorer. But most of the doctors I know still have plenty of room to meet the demand for cataract surgery, which is a repetitive operation highly dependent on fast turnover, minimal complications and the efficient use of operating room time.”

In previous years, cataracts were taken out and replaced with rigid implants. There are now implants which are less rigid and foldable so they can be inserted with smaller incisions.

“We can do modern cataract surgery now with no stitches and no shots,” Berry said. “We just use eye drops for anesthesia most times, although doctors still use a shot for people who have trouble holding the eye still. When possible, we like to avoid risks of putting a needle behind eye and damaging something. When we just use topical anesthesia, and no shot behind the eye or stitches, patients can get off the table, reach down, pick up something heavy and not hurt anything.”

For years patients have been saying to Berry when scheduling a surgery, “You are going to do it by laser, right?” But he said while laser surgery is easier on the doctor, it is more expensive and that expense is not covered by most insurance or government programs.

“The 12 eye doctors together here had a big discussion and interviewed companies that sell the Femto laser,” he said. “But we took a look at the literature to see if there is proof the clinical outcome is better, and it really hasn’t been proven better than hand surgery.”

There have also been real advances in retina surgery, particularly for macular degeneration. An injection in the eye to treat macular degeneration is now the most common surgery done in the U.S. – more common than bypass surgery or any other surgery. Berry said that is because people with macular degeneration may need an injection once a month for many years.

“There are ten retina doctors here at the Eye Care Arkansas, and they tell me they do up to 1,000 of those injections per year each,” Berry said. “There are lots of people with macular degeneration and the number of elderly is growing. That requires lots of injections for a treatment that is a major step forward for common retinal disease. It works well for macular edema, too.”

Another important advance is minimally invasive glaucoma surgery (MIGS) which involves inserting a device to help relieve pressure in the eye. There are a number of new products including micro stents of titanium one millimeter long that can be implanted in the eye.

“MIGS is going to be one of the things for the future,” Berry said. “As MIGS gets better and better, more and more doctors will go through the training to do it. However, there aren’t that many patients because new drops work better than old ones. So we do less glaucoma surgery, and what glaucoma surgery we do is more effective.”

Another fairly new and exciting development is the use of the artificial cornea, like the Boston keratoprosthesis, said Tayyeba Ali, MD, a cornea and uveitis specialist and assistant professor at the Harvey and Bernice Jones Eye Institute/University of Arkansas for Medical Sciences. Ali is one of only two cornea surgeons in the state trained to implant the artificial cornea.

“This is exciting for patients with repeated former transplants that have failed or with pathology that is expected to fail after a routine transplant,” Ali said.

Previously, all types of corneal pathology would require a full-thickness corneal transplant from a donor. Now, Ali said, as doctors have learned more about the anatomy of the cornea, techniques to perform partial thickness, lamellar transplants have changed the way physicians address corneal transplantation. It has become more routine to simply remove the part of cornea that is damaged, thus transplanting less donor tissue.

“The benefits include a theoretical decreased risk of rejection and results in a quicker time to recovery and full visual potential, as it is a less invasive procedure,” Ali said. “We replace less of the host cornea. It is a safer, ‘better’ surgery, when it is indicated.”

The field of ophthalmology is very dynamic. Ali tells her patients that the great news is that there are options available that patients didn’t have access to before.

“But, sometimes the best option is to do nothing,” Ali said. “It is important and key to have a thorough screening examination and know which patient would be a good candidate for some of these unique procedures. There are complications and significant issues to look for when treating patients with these newer techniques and technology. It is not that this is to be used on everybody.”

Ali completed her fellowship training in cornea and uveitis at the number one ranked eye hospital in the country, the Bascom Palmer Eye Institute in Miami. While there, she saw some of the complications that can result from these newer surgeries. “Sometimes watchful waiting is not a bad idea,” Ali said.