Thanks to technological innovation, we have more precise diagnostic methods and tools in the field of ophthalmology that have improved the surgical results of patients.
Ophthalmology has improved a lot and digitalized for the benefit of patients, professionals, and the healthcare system. This has been made possible by overcoming challenges and making use of opportunities. The efforts made by the health technology sector to develop innovative technologies that improve the health and quality of life of ophthalmology patients have become clear. The innovation developed by health technology companies has brought about a revolution in the field of ophthalmology that has resulted in better clinical practice and an important advance compared to ocular pathologies. This article aims to review a few of the innovations made in the field of ophthalmology.
Experts point out that the latest research in ophthalmology focuses on refractive and cataract surgery, in addition to the surgical approach to glaucoma. In the coming years, advances are expected in femtosecond lasers for cataract surgery and correction of refractive errors. Researchers are also expecting innovations in the field of intraocular lens design and materials, as well as in equipment that allows safer and more efficient surgery on both the retina and the anterior pole.
In addition to reducing the time spent in hospital and the number of days off work, the use of technology reduces the rate of infections and the risk of healthcare complications. In this sense, the introduction of new equipment is essential for the management of patients with retinal diseases.
Technological innovation in ophthalmology has helped to develop innovative products and solutions. There are currently many areas under development: faster and more accurate imaging systems; less-damaging lasers; smaller and safer surgical instruments; high-resolution 3D surgery systems and teaching utility; and even bionic eyes.
NEW OPHTHALMOLOGICAL TECHNIQUES FOR CORNEAL TRANSPLANTS
The cornea is the main lens of the human eye. As an essential characteristic,
it must be transparent and regular. Some diseases, trauma, and surgical operations deteriorate these properties of the cornea, and the only treatment is transplantation.
Advances in medicine are such that there are various techniques to carry out these transplants, depending on the characteristics of each patient. To date, researchers have carried out many complete corneal transplants, and in 2018 researchers began to perform the so-called endothelial transplants. Regarding the technique, a few years ago, only the so-called complete transplants could be performed, although currently the so-called front partials and rear partials of the cornea can be carried out. Endothelial transplant is a technique that, in general terms, allows the corneal endothelium to be replaced, exclusively selecting the innermost layers of the cornea, without affecting the middle layers. In this way, a controlled surgery is performed, through a micro-incision, which allows rapid rehabilitation and avoids fragility in the face of trauma after other types of interventions. Consequently, the patient’s recovery is faster, and the degree of vision offered to the recipient (between 90 and 100%) is much higher than that achieved with traditional transplantation. In addition to the benefits for the patient, another important advantage of this technique is that, conceptually, it would make it possible to take advantage of the same donor cornea for two different patients.
NEW TRENDS IN CATARACT SURGERY
Cataract surgery is the most commonly performed surgery in the world. Its modernization is constant, and recent technological advances make it possible to correct more refractive errors, reduce the risks associated with surgery, accelerate visual recovery, and reduce the incidence of postoperative complications. Recently, we have seen the introduction of monofocal EDOF, trifocal IOLs, torsional phacoemulsification, and corneal micro-incision. In the prevention of endophthalmitis, the novelty now includes an intracameral injection of antibiotics. The future of cataract treatment probably lies in the eventual elimination of phacoemulsification surgery in favor of laser surgery, which is safer and more reproducible.
Topical anesthesia consists of injecting an anesthetic into the anterior chamber after opening the eye for the first time. It makes it possible to perform an intervention without pain provided that the surgery is of limited duration, which new surgical techniques allow. Topical anesthesia largely replaced local anesthesia with a retrobulbar injection of anesthetic, which involved paralysis of the intraorbital muscles of a few hours, was often uncomfortable for the patient postoperatively, and which required covering the eye with a bandage overnight intervention to avoid any troublesome diplopia. In addition, retrobulbar anesthesia carried a risk of orbital hematoma, damage to the optic nerve, or even occlusion of the central artery of the retina.
INTRAOCULAR IMPLANTS: MULTIFOCAL, ACCOMMODATIVE AND TORIC
Cataract surgery is modernizing with the arrival on the market of new intraocular implants and the publication of convincing results on multifocal implants. Until now, only monofocal implants have been available to replace the lens of the eye, which could only provide the patient with a clear image for near or far vision. Like progressive spectacle lenses, new multifocal implants allow the patient to have a clear image at all distances. These implants are based on an optical system designed to separate the light refracted by the implant to two main foci: one for far vision, the other for near vision.
Torsional phacoemulsification is gradually replacing longitudinal phacoemulsification, which still remains the most widely used technique in the world. In longitudinal phacoemulsification, the tip of the phacoemulsifier swings back and forth to fragment the lens nucleus, and the tip can become stuck or cause turbulence when the size of the fragments formed is too large. The twisting technique, introduced in 2005, uses a lateral oscillation of the tip, which produces smaller sized core fragments with each movement. This makes phacoemulsification of the nucleus of the lens more efficient and safer by reducing movements in the anterior chamber, the energy required, as well as the production of heat (and, therefore, the risk of burns on the incisions).
In 2010, the torsional technology was further improved by a system whereby the machine itself chooses to push back the fragments that risk causing an occlusion, which further improves the stability of the anterior chamber of the eye and, therefore, the safety of the intervention.
Thus, the field of ophthalmology has improved a lot in recent years as a result of innovation and digitalization in different aspects. Modern cataract surgery can greatly reduce intraoperative risks, such as bleeding and rupture of the posterior capsule, with the consequent risks of inflammation and retinal detachment, and the major postoperative risk of infection. The quality of vision and the speed with which it is obtained after modern surgery have been significantly improved by various means such as new intraocular implants and the reduction of surgically induced astigmatism. In addition, patient comfort has improved significantly with the reduction in operating time and the pain caused.
Looking ahead, some challenges still need to be addressed, such as the complete elimination of postoperative refractive errors, the total restoration of accommodation, the elimination of reproduction of residual cells of the crystalline cortex (and, thus, the secondary fibrosis), and the elimination of intraoperative risks related to the surgical technique and the surgeon. Finally, the recognition of the major genes involved in the metabolism of the lens and the development of cataracts could contribute to the development of preventive therapy resulting from genetic engineering.