The carpet cleaners and house painters of Utah don't know it, but Dr. Roger P. Harrie and his colleagues have cut into their business.
Most people who live long enough eventually develop eye cataracts. For the elderly, the clouding of the eye's lens takes on a brownish-yellow tone that affects the person's vision.When ophthalmologist Harrie removes cataracts from an older patient's eyes, his vision suddenly clears up. It becomes much brighter and sharper.
Often these people were ready to have their walls repainted or carpets cleaned because of a perceived dinginess. Then they go home after surgery and discover there's nothing wrong. "It was that yellow-brown cataract they were looking through," he said.
Harrie and a fellow ophthalmologist, Dr. Bryce G. Barker, will be the guest experts Saturday on the Deseret News/Intermountain Health Care offering, Health Care Hotline.
Harrie is on the staff of Primary Children's Medical Center and a clinical professor at the University of Utah's Moran Eye Center. Barker is with the Salt Lake Clinic. Both are on the LDS Hospital medical staff.Barker and Harrie will be prepared to answer a variety of questions called in by the public, from laser ophthalmology to new treatment for glaucoma to corneal implants and cataract surgery.
According to Harrie, cataract surgery is so advanced that it is an outpatient procedure nowadays. "When I trained at UCLA years ago, the patient spent several days at the hospital. We used about 10 stitches to close the eye, and he had to wear big, thick cataract glasses after the surgery."
Now the surgery requires only a small incision. A plastic lens is implanted and the patient does not need a stitch.
The idea of implanting plastic lenses was the brainchild of an Englishman, Dr. Harold Ridley, who realized that the body can tolerate plastic well. During World War II, Ridley treated fighter pilots who were hit in the eye by fragments of their shattered plastic windshields. With most material, the eye reacts violently to foreign objects. But the pilots' eyes did not reject the plastic.
Ridley had the idea to implant plastic lenses. "He had a company fabricate the implants of this material, which is a special plastic," he said. However, the crude technology available in the 1950s meant that satisfactory plastic lenses could not be manufactured. There were problems with size and finish.
In 1979, when Harrie was finishing his university training, plastic lenses suddenly caught on again. By then manufacturing had improved so much that the material was satisfactory.
"They're fantastic," he said. "They're highly finished. They're standardized, they're FDA-approved, so the success rate is very, very high."
These implantable plastic lenses are made of a new material that makes them soft enough to fold over, so they can be inserted through a small slit in the cornea.
During cataract surgery, an instrument called a microkeratome slices a tiny trap door into the cornea, which is the curved bubble of transparent material above the lens.
Then the ophthalmologist inserts a needle that vibrates 40,000 times a second. The needle's ultrasonic energy dissolves the lens, including the cataract. The needle's suction tip sucks out the dissolved material.
A soft, plastic, intraocular lens is folded and fitted through the cornea's trap door. It unfolds and takes its place in the eye, and the flap of corneal material is replaced. The patient has clear vision, often for the first time in years.
"About a million people a year in this country have cataract surgery," Harrie said. "We feel that as people get older, eventually most people get a cataract at some time."
Cataracts become more common after age 60. By age 80, most people have developed at least one.
"The presence of a cataract doesn't mandate surgery," he said. "I really count on the patient to kind of guide me. I don't push cataract surgery."
Instead, he asks the patients how their cataracts affect their reading, driving and other daily activities.
With older people, cataracts are dense. The lens seems to harden, making a yellow-brown cast. Cataracts in younger people are more like a smudge.
The change to outpatient status has driven down the cost of cataract surgery because the patient no longer has to stay at a hospital for several days.
In Utah, the average cost is about $2,500 to $3,500 per eye. Insurance usually covers it. Medicare is the most common insurance carrier for cataract patients, and the federal program does pay for the operation. *****
Additional Information
Where to call
What can you do to keep your eyes healthy? Can operations really restore your vision so you don't need glasses or contacts?
Dr. Bryce G. Barker and Dr. Roger P. Harrie, both on the medical staff of LDS Hospital, will be available to respond to queries from the public Saturday during the monthly feature, Health Care Hotline.
To reach Harrie and Barker, call the toll-free hotline number between 10 a.m. and noon Saturday. The number, 1-800-925-8177, can be reached from throughout the region. Callers will not be asked to give their names.