Cutting edge cataract surgery doesn't require blades

Dr. John Jarstad
Dr. John Jarstad

Do these words look blurry to you? More than half of all Americans will have had a cataract by the age of 80, according to the National Eye Institute.

Typically caused by discoloration or buildup of proteins in the eye's lens, cataracts harm the ability to see in colors and fuzz up vision in a way glasses can't correct.

The Mason Eye Institute at the University of Missouri now offers a new procedure to remove cataracts and correct vision using a laser - no scalpels needed. The institute is one of only four locations in the state to offer the technique.

"It's really kind of the first time we've been able to do the cataract surgery robotically," said Dr. John Jarstad, associate professor of clinical ophthalmology at the university. "In the past, everything was done by the surgeon with the little microscopic scalpel."

Jarstad was one of the first physicians in the U.S. to begin using this technique. Since 2012, he's successfully done it more than a thousand times.

Aside from removing the cataract, this technique corrects astigmatism and can also fix nearsightedness and farsightedness. During the surgery, a new artificial lens is inserted into the eye, which can work like a built-in set of contact lenses (or bifocals or trifocals, depending on what the patient needs).

Diane Linneman, a Columbia resident, had the surgery done on one eye five weeks ago and the other eye on Friday. She said in the first eye, she's already seeing a huge difference.

"My vision the other day was 20/25," she said.

Jarstad said it's superior to the traditional technique because it's far more precise.

"The best analogy would be asking someone to draw a perfect circle," Jarstad said. "You can draw really close to a perfect circle, but a laser can do it like a stencil."

It's an outpatient procedure that takes about an hour and a half from arrival at the office to departure afterwards, plus a week for recovery.

"I just did three of them this morning," Jarstad said.

He explained the whole process.

"Once a patient is found to have cataracts, they'll get some tests - measurements of their eyes - that'll determine the prescription lens they'll need after surgery," Jarstad said.

On the day of the procedure, the patient shows up at the outpatient surgery center at the University of Missouri Women's and Children's Hospital.

"You don't really have to do a lot of prep for it," Linneman said. "You just have to not eat or drink anything after midnight the night before."

After checking in and having vitals taken, the patient gets drops in his or her eyes to dilate and numb them. These take effect in about 15 minutes.

"We don't use needles anymore," Jarstad said.

Then the patient comes back to the operating room and gets cozy under the laser. A soft contact lens-like extension of the machine docks to the patient's eye, and the patient must focus on a lighted target to keep their eye in the correct position while the laser goes to work.

All the information about the patient - any astigmatism, the size of the cataract and more - has already been programmed into the machine.

"I had astigmatism, and he totally corrected that with the laser," Linneman said.

While it sounds like the setup for a James Bond torture scene, it's painless and quick. According to Linneman, Jarstad will answer any questions you have throughout the procedure.

"It takes about 30 seconds to make incisions, correct astigmatism and break up the cataract," Jarstad said.

Next it's on to the main operating area, where the doctor suctions out the sliced-up cataract and puts the new lens in. Jarstad highlighted two types of premium lenses available: trifocal and Crystalens.

Trifocal lenses have different zones designed to focus close up, at a middle distance and far away.

Crystalenses are flexible and can be focused by muscles in the eye, just like the patient's original lens.

After sitting in the recovery room for a little while, the patient is free to go.

"They put a patch over your eye, and then you go home," Linneman said.

The patch comes off at the follow-up visit that same day.

"We usually see our patients again the same day and check eye pressure and vision and see them back in about a week," Jarstad said. "By then, their vision is usually pretty close to 20/20."

During that week, the patient wears an eye shield at night to prevent unintentional rubbing.

"When we started doing cataract correction surgery 25 years ago, it used to take six weeks to recover," Jarstad said.

Patients also have to use eye drops for a few weeks, Linneman said.

"I got my first eye done a month or five weeks ago," she said. "It probably has had less discomfort in it, as time has passed and it's healed, than wearing my contacts (caused)."

The surgery does have a couple limitations. If a patient has a tremor or movement disorder that makes them unable to look steadily at a certain point for 30 seconds, they can't have the laser-assisted surgery.

There's also a condition called a morgagnian cataract, when the cataract has been left untreated too long and liquefied. The laser surgery isn't designed to treat it.

But for all other types of cataracts, it works well, Jarstad said.

What's the cost?

"Medicare and private insurance won't pay for the premium lenses like the trifocal or the Crystalens, which cost about $1,900 per eye (after a $100 insurance credit)," Jarstad said.

Linneman opted for the Crystalens and said it's working well for her.

Medicare and private insurance do cover cataract surgery, but the robotic laser treatment isn't yet recognized by insurance companies.

"We do have to charge extra for that," Jarstad said. "It's about $1,000 more."

For Linneman, it was worth it.

"I've worn glasses or contacts since first grade. And I'm not absolutely positive, but I don't think I'm going to need any further correction," she said.

The current waiting period for the surgery is about 4-6 weeks. For more information, call 573-884-3937.