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    Phaco turns 50

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


    Randall Olson, MD, chairman, Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City

    When Dr. Olson performed his first phaco in 1975, he said the equipment was archaic by today’s standards.

    “Fifty mm Hg was high vacuum, and post-occlusion surge was still scary,” he said. “Many felt 30 mm Hg was as far as you could go. You hand-tuned the instrument, and power was dial-controlled so when you were on, you got all of it instantaneously. No wonder corneas were grossly edematous!”

    Three advances within phaco that made a night-to-day difference were recognizing and improving control of post-occlusion surge so the vacuum could be used more safely, linear control of ultrasound power to instantly vary what was needed to the right amount, and ultrasound tip power modulation for improved efficiency, Dr. Olson believes.

    He also praised techniques that improved phaco. “Hydrodissection and delineation made it safer,” he said. “Divide-and-conquer was the first major nucleus disassembly breakthrough, followed by chop. Essentially, all else has followed from there.”

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