[nluken]

People here are rightly pointing out that there's still room for improvement with this (and almost any) kind of surgery, and the article talks about the accessibility challenges of making procedures like these more widely available, but after reading up on the history of this procedure it's hard not to see modern surgical techniques as a kind of man-made miracle. Great read.

[onlyrealcuzzo]

It's nuts to read this technology has only been around since 2008. It seems like it's been around forever.

I'm not that old, so that's part of it. And also, 17 years is a long time in tech.

Regardless, it is a modern miracle that there's been this much progress in that short of a time period.

The article stats a 95% success rate - which doesn't seem great, but <0.5% of incidents have serious complications, most of the other 5% are temporary minor complications.

[epmaybe]

Eye surgeon here: FLACS isn't really that amazing. I would actually argue that a man made incision using steel or diamond (yes, diamond) is better than the incision made using the femto laser for long term safety/sealing. Number of studies have borne this out.

95% success rate seems low. you need to define success in this scenario. Are we aiming for 20/20 vision outcomes? Just getting the cataract out in full?

[pndy]

It's here already - at least for the developed countries. It's both thanks to this multitool used to handle the surgery - destroying, removing natural lens and replacing it with an implant, and technology that allowed creating customized intraocular lenses pretty fast.

My mother had her eyes done 2 years ago with one month break between. I did set timer on second surgery and it was just 20 minutes once she was inside. The only thing we had to care about were drops administered 4 times a day before and after the procedure - for once multiple alarms on my phone were useful. And of course control visit with dressing removal that happens for every patient on second day.

In my city a duet of two doctors runs an ophthalmology clinic and seems they have some good contracts with health services because they're always busy and have shorter waiting lists than clinic at our local hospital. Both women handle a queue of about 20 people and each weekday is dedicated to a different issues, with serious surgeries reserved for weekends.

I ask one of doctors if failed cataract surgeries happen because I was concerned before the first time my mum had it. She said that these are extremely rare but if a patient needs another it happens again pretty fast. The issue might be with lens that moved inside due to e.g. patient activity shortly after the procedure.

I do remember some short documentary about probably an Indian surgeon who treated eyes of North Korean elderly people. He also visited other places around the world as sort of personal goal to give new eye care technology in places where is needed but socio-economic conditions do not allow it. I'll try to find that unless someone happen to know that man's name.

[eyeundersand]

His name is Sanduk Ruit and he's Nepali. A huge inspiration!

[pndy]

Thank you; I managed to find that documentary but it seems it was a part of large thing: https://www.youtube.com/watch?v=TXYokXfbrWs

Here's another by DW: https://www.youtube.com/watch?v=xz729FOOk94

[pantulis]

The miracle is when they put a _graduated_ lens and you get cured of cataracts and myopia in a procedure where you are awake and can perfectly ntoice how while the lens is being inserted the blinding lights on top of you become more and more defined.

It's nothing short of a man-made miracle but I have to say it's also very umconfortable and stressful for the patient.

[BXLE_1-1-BitIs1]

The surgery is not fun. The worst part was the cannula for the subtenon block - not painful, but my anxiety at something being poked into my eye socket went through the roof. My sister opted for sedation after she heard of my experience.

The second operation was easier as I told the surgeon about my reaction to the subtenon block and he put some topical in the right place making it much easier. However the residual anxiety from the first operation remained. All that said, I've had rougher times at the dentist.

I opted for optimal vision at arm's length with a monofocal lens. We spend most of our days around the house. Bifocals with plano below work fine for outdoors, driving and flying (check with your aviation doctor before lens selection as aviation authorities are strict in what lens options are allowed). The depth of field has turned out better than I expected, but I use 1.25 diopter drug store readers when I'm using my tablet at home and put it at arm's length in the coffee shop.

The results are absolutely wonderful and I feel gratitude every time I step outside.

[epmaybe]

Most people don't get blocks nowadays for cataract surgery. I will do so for patients with wandering eye movements or for more difficult cases, or for more invasive surgery besides cataract surgery. I just did a cataract surgery on a young patient today using topical numbing drops. But I have them monitored by an anesthetist with mild sedation during the entire case.

[pantulis]

For my second operation the surgeon basically suggested using some drug ending in -pam (perhaps it was Valium) and they wouldn't provide it over the counter so I had to get a proper prescription, which somehow pissed the surgeon off. At the end of the day, yes, a dentist is worse but the phobia of someone tinkering with your eye remains.

I wanted something simple and didn't want to mess with multifocal lens inside my eye, so opted for monofocal and high myopia correction like around -12 diopters, so after a couple of weeks my far vision felt like I was Superman and my near vision remains poor with zero accommodation.

5 years down the line, it seems the myopia is keeping its course and I need some small correction for far, middle, and reading distances so my drawers are a mess of glasses.

But I keep being grateful for this, I can walk the streets without anything in my eyes and this is something I don't have any memories I can recall. So it's a wonder.

I would gladly go again for that surgery even through the discomfort!

[temp_praneshp]

Possibly Lorazepam[0]? Relatively common anti-anxiety drug (I have a couple of them in my pocket all times because it can help during seizures).

https://en.wikipedia.org/wiki/Lorazepam

[pantulis]

Probably, yes.

[mschaef]

I had it done about eight years ago... there's nothing quite like waking up after a fifteen minute procedure and seeing better than you have without correction since you were five.

> It's nothing short of a man-made miracle but I have to say it's also very umconfortable and stressful for the patient.

I think I must be strange, either in my reaction to the stress or the way I chose to manage it during my surgery.

I explicitly wanted to be somewhat awake during the procedure to see what was going on (how many chances do you get to see your lens emulsified from the inside)... and I remember having short conversations with the surgeon during the procedure. (She'd been concerned about zonular laxity, and we discussed during the procedure that she didn't see evidence.)

This is not something I'd want to reproduce if I didn't have to, nor would I suggest it as a general approach, but given that it was necessary for me, it was amazing to see it first hand.

My second procedure (second eye) was a little more stressful than the first, but for me all the material stress (which was significant) was in the run up and anticipation.

[craftkiller]

> it's also very umconfortable and stressful for the patient.

This is what concerns me. If someone took a blade to my eye, I would be screaming, vomiting, and thrashing until I lose consciousness even though my rational brain knows the surgeons are helping. Are there options for the irrationally mutilation-averse people such as myself (like general anesthesia) or are my options just go blind or re-enact a Saw movie?

[el_benhameen]

I worried about this too. I had surgery for a congenital cataract at 27 or so. I was conscious-ish and remember hearing the surgeon talking and doing something to my eye, but they put you on some _wild_ drugs and I absolutely did not care.

[craftkiller]

Ah thank you, that alleviates my concerns a lot. Now I just hope they don't think I'm a drug-seeker when I tell them to dial the drugs up to 11 :-D.

[el_benhameen]

Not to worry there, either! I think the drugs are pretty standard, are not opiates, and honestly I think that most humans understand that “if you’re gonna poke me in the eye, at least make sure I’m good and sloshed” is a pretty reasonable ask.

[bregma]

I swear there would be nothing but heaps of smoking machinery and mangled human limbs and entrails in the operating theatre in my wake and they'd find me cowering in some far corner of the building curled up in a foetal position.

I can't even tolerate a glaucoma test and cut the optometrist off mid-sentence when he starts to suggests it.

But that's me. I think my wife would do her own eye surgery with just a mirror and some kitchen knives. Ugh, I wish I hadn't thought of that. Excuse me while I go try to stop the panic.

[pndy]

At least cataract surgery once done won't be likely repeated. But there's also the age-related macular degeneration that goes by... AMD acronym. The treatment method for wet form involves intraocular injections, which basically means a series of shots in the affected eye, up until a "pocket" seen during eye tomography scan sizes down and vision improves.

My mother is going to have 8th shot this year and 13th total since doctor decides to test her. She describes the injection as "potent hard pop". All patients gets the anesthetics and some moisturising-softening agent so needle could get in easier.

Seeing the queues many times I can tell this problem concerns senior women, less frequently men and people of both sexes below 60. Tho, I once saw a guy who was around mid 40.

It's surely not fun to get a needle into your eye month by month but mum and all the other people in the clinic are beyond that already.

[xp84]

Me and you think the same. For me, even just knowing they’re going to be cutting on my eye and or using lasers to burn parts of my eye, combined with the nonzero risk of permanent vision worsening has made me permanently uninterested in eye surgery (such as lasik). Even if I could be put under for it.

[JadeNB]

It sounds like it must inevitably be uncomfortable and stressful—why do they do it with the patient awake?

[junikaefer]

General anestesia is pretty secure, but 1:100.000 still end deadly. Thats why general anesthesia is avoided whenever possible, especially for small procedures like that. It’s also way more complicated, requiring a pre-medication talk, an anesthetist being present and supervised rooms where patients can wake up.

[pantulis]

I've wondered quite a lot about this. Look, the last thing you want to hear while the procedure is being performed is the surgeon saying: "Please, stop moving your eye. Help me out here".