A new tool at Four Corners Eye Clinic ensures that surgeons can more precisely replace lenses in the eyes of cataract patients.

The clinic’s intraoperative aberrometer, or ORA, allows doctors to adjust plans for surgery while they are operating, Dr. Joshua Zastrocky said.

The ORA is mounted on the operating microscope and uses infrared light to assess eyes and help guide the surgeon, who is implanting either new clear plastic lenses or corrective lenses that can eliminate the need for glasses and contacts.

“It’s really an evolution of cataract surgery,” he said.

Cataracts are caused by the protein in the lens of an eye clumping together. Over time, the clumps can cloud a person’s vision. Cataracts need to be removed when the vision loss starts to interfere with daily life, which is generally after age 60, according to the National Eye Institute.

Marilyn McCord, 77, had cataract surgery at Four Corners Eye Clinic last fall because she couldn’t see very well out of her left eye anymore.

“The very next day I could see better out of that left eye than I have for decades,” she said. The change was so dramatic she asked her doctor how quickly she could have cataract surgery on her right eye.

She also had corrective lenses implanted in both eyes, and the ORA was used during her surgeries to help guide the surgeon.

One lens in her left eye improved her distance vision and the one in her right eye improved her near vision

“They are still learning to work together the way they need to,” she said. But they largely replaced her need for glasses.

Cataract surgery is one of the most common operations in the U.S., and doctors with Four Corners Eye Clinic operated on 1,132 eyes last year.

The ORA takes about 40 measurements in less than 5 seconds and provides information that prompts a change in Zastrocky’s original plan about 40 percent of the time, and allows the surgeon to select more customized corrective lens, he said.

“We are very confident in what we have implanted,” he said.



Before surgery, Zastrocky uses iTrace, a machine that relies on light waves, to fully understand problems with the patient’s vision, such as astigmatism.

The measurements help Zastrocky narrow down which lenses, among the 2,000 options, a patient could need.

To replace lenses, the surgeon numbs a patient’s eyes and uses a diamond blade to make small incisions in the eyes, he said.

Once the lens is exposed, a small instrument with a bored-out needle on the tip vibrates at an ultrasonic pace to break up the existing cloudy lens and suck it up.

Cloudy lenses can affect measurements before surgery, and once those lenses are removed, the ORA can provide better measurements.


The ORA shines a low beam laser light into the eye and measures the light the eye reflects to provide the surgeon with real-time information that can be used to select the new lenses.

The new plastic lenses are inserted through a 2.5-millimeter incision and they unfold across the eye. Small arms on either side of the lens spring out to center the lens, he said.

Once in place, the ORA can guide the surgeon to rotate the new lenses in the eye, he said.

The whole procedure lasts about 10 to 15 minutes, and the incisions seal themselves, he said.

The ORA is particularly helpful to surgeons when they are working with a patient who had corrective eye surgery with lasers or blades, Zastrocky said.

Many of these corrective surgeries alter the shape of the cornea, a lens that bends light, and the ORA helps accurately measure the surfaces of the cornea and guide a surgeon’s decisions, he said.

Cataract surgery is generally covered by insurance companies because it is a medical condition, Theine sad. But patients may have to pay for corrective implants, and the price varies by the type of lens a patient needs.

Monofocal lenses that improve distance or near vision are typically covered by insurance, according a pricing sheet provided by the clinic. Lenses that improve both can cost $2,300 per eye.

Source: The Journal