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    Phaco turns 50

    Technique, technology transformed cataract surgery; evolution continues for benefit of physicians, patients


    Samuel Masket, MD, clinical professor of ophthalmology, David Geffen School of Medicine, Jules Stein Eye Institute, UCLA, and founding partner, Advanced Vision Care, Los Angeles

    Like his colleagues, Dr. Masket has seen how advances in fluidics, phaco energy modulation, and phaco techniques have made phacoemulsification a safer and more efficient procedure. Yet another advance he addressed is tip design.

    “The original phaco tip was a circular hollow tube that had a straight or slightly beveled angle,” Dr. Masket said. “People have been able to change tip design to allow the surgeon to use the emulsification tip as a surgical tool. As just one example, an angled phaco tip, as it turns out, provides a greater concentration of energy at the end of the tip.”

    He went on to describe his 20-plus years of performing bevel-down phaco, which allows the surgeon to impale the nucleus so that the tip is more easily occluded by lens material, facilitating chop and other maneuvers.

    However, if Dr. Masket had to pick one advance for the great success of cataract surgery across surgeons and regions, it would be the development of ophthalmic viscosurgical devices (OVDs; viscoelastic material).

    “They expand time and space during surgery, while cushioning and protecting ocular structures,” he said. “It’s hard to talk about phaco without talking about what the OVDs have done for the science, and art.” 

    He believes the future will include greater use of laser energy although probably not femtosecond laser-assisted cataract surgery as it is used now. Instead, developers may find ways to harness laser energy for more efficient surgery.


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