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15 Oct 2018

Evolution of Cataract Surgery

Evolution of Cataract Surgery

Cataract surgery involves removing the natural lens of the eye and replacing it with an artificial one. The eye is measured pre-operatively that allows a lens of appropriate power to be chosen to optimize vision without glasses for distance. Other, more advanced lenses are now available that can correct astigmatism (asymmetry on the corneal surface) or also allow the patient to see in the distance and read without glasses. This latest advance has resulted in the procedure: ‘Refractive Lens Exchange’, designed to get the individual out of both reading and distance glasses whilst retaining good depth perception.

Although cataract surgery has been performed with an intraocular lens implant since 1945, it has been a constantly evolving field and the procedure has now become very refined. Going back 30 years, patients were hospitalized for 6 weeks with sandbags either side of their head to keep it still. Now the procedure takes 15 minutes under local anesthetic, the individual returns home within an hour and sees well the next day.

There are further recent advances making the operation safer and more accurate. Dr James Genge is at the forefront of these techniques and is a sub-specialist in cataract surgery. They include:

Micro-incision Cataract Surgery

Most surgeons enter the eye through a 2.75 mm incision through the periphery of the cornea. Dr Genge now performs exclusively micro-incision cataract surgery that uses a 2.2 mm incision. The advantages of this more advanced technique are numerous:

  • There is a more stable anterior chamber (the front of the eye) during the operation that minimizes movement of structures within the eye and makes complications such as a capsule tear extending or retinal detachment less likely.
  • There is less induced astigmatism, which is a change in the shape of the cornea due to the incision. This makes visual outcomes more predictable and translates into better vision.
  • There is a reduced risk of a wound leak postoperatively. This means the infection risk is lower.
  • The wound is structurally stronger in the case of any future potential trauma.

Soft –Shell Technique

The inner lining of the cornea is a single layer of cells that pumps water out of the cornea to maintain it’s transparency. Any surgery within the eye can damage these cells and they do not replicate, therefore protecting them is paramount. Dr Genge uses a technique utilizing two visco-elastic substances (gels used during the surgery to create space) to form a protective coating on these cells to maximally preserve them. This results in clearer vision and better long-term eye health.

Phaco-chop technique

An ultrasonic probe is used within the eye during cataract surgery to fragment and remove the lens. Different techniques are used to disassemble the lens’ structure whilst retaining the bag of tissue surrounding it, this bag serving as the receptacle for the new artificial lens.

The majority of cataract surgeons use a technique called ‘divide and conquer’ where the energy of the ultrasound probe breaks the lens apart.
Dr Genge is one of the 10% of cataract surgeons who have mastered the Phaco-chop technique where a special instrument breaks the lens apart instead of relying on ultrasound energy. Although harder to master, the advantages are many:

  • Less energy inside the eye from the ultrasound reduces potential damage to the endothelial cells, thus provides better long-term corneal clarity and vision. A divide and conquer technique uses on average 1.5 minutes of energy, a chop technique usually under 6 seconds.
  • Less pushing forces on the lens capsule reduce the risk of a capsule tear, significantly improving both short and long-term outcomes.
  • The procedure is quicker, always a positive for a patient under local anesthetic.

Torsional Ultrasound

Standard Phacoemulsification ultrasound used in cataract surgery uses longitudinal pulses to impart the energy required to break apart the lens. Dr Genge utilises exclusively the Alcon Centurion Phacoemulsifier with 100% torsional or rotational movement of the phaco probe (OZIL) as opposed to longitudinal. This as two principal advantages:

  • Reduced energy inside the eye allowing maximal preservation of the corneal endothelium with better long-term eye health.
  • Reduced possibility of the probe inadvertently rupturing the lens capsule.

Advanced Lens selection

Dr Genge is amongst the most experienced surgeons in Australia using the most advanced lens technology.

He utilizes the most advanced  Multifocal IntraOcular Lens that allows the individual to see both in the distance, use a computer and to read without glasses whilst retaining fine depth perception as both eyes are doing the same thing. It provides permanent independence from all glasses. As Dr Genge is an experienced Laser Eye Surgeon, using the Alcon Refractive Suite, the world’s most advanced laser system, he is confident in getting a great result for the patient as he can fine-tune the outcome if required. This is an essential factor in any surgeon using this more advanced intra-ocular lens technology.

The advanced Multifocal lens technology lens now comes in a toric form which, when orientated in the optimal position within the capsular bag after implantation will correct pre-existing corneal astigmatism. This gives the patient the best quality vision with a minimal degree of intervention.


Dr Genge has a fellowship from Moorfields Eye Hospital, London, one of the worlds leading eye institutions in complex cataract surgery, Laser Eye Surgery and Corneal Transplantation. Each patient is approached with the same fine attention to detail and an individualised solution is formulated and enacted to achieve what the patient’s goals are.

Call us on 02 9981 1771 to make an appointment.