Vision quest Q&A: Dr. Kerry Solomon, a Charleston cataract and LASIK surgeon, talks about cutting-edge treatment

Dr. Kerry Solomon, a nationally recognized cataract and LASIK surgeon based in Charleston for nearly two decades, is excited about the first major advance in cataract surgery since starting his practice in the early 1990s.

Solomon is largely responsible for getting one of only a dozen LenSx femtosecond lasers in the world to be placed at the Physicians' Eye Surgery Center in Charleston earlier this summer. In layman's terms, the laser makes precise, customized incisions just before the actual surgery takes place.

Solomon envisions the technology to hold the same promise for cataract surgery as LASIK, or laser-assisted in situ keratomileusis, had for vision-correction surgery in the early 1990s.

Q: You started your career in conjunction with a major advance, LASIK, which evolved by leaps and bounds. In a nutshell, how has it improved?

A: In the late '90s, the 20/20 rate (post-LASIK surgery) was 60 percent. Today it's 95 percent. In fact, today we have 50 to 60 percent rate of 20/15 or better. That's how precise and how far LASIK has come in just the last five to six years.

Q: From your perspective, how significant is this new technology, femtosecond laser?

A: This is the LASIK for cataract patients. Until the late 1980s, surgeons manually removed cataracts. We'd have a very large incision that required stitches. People would have to refrain from activities for six to eight weeks, then we'd have to remove the stitches, and then they would be fitted with glasses.

In the late '80s and early '90s, ultrasound came around, and it allowed us to make the incision smaller, made the procedures more precise and safer, but they are still manual.

This is the first true advance in cataract surgery since then. We are now taking femtosecond technology, which made LASIK bladeless, and applying it to cataracts.

Q: Some people who have undergone cataract surgery think it was done by a laser, but that's a misconception, right?

A: For decades, people have said they had laser to remove their cataracts. There has never been such a thing. It was ultrasound, which was manual and hand-held and it's a wonderful technology. This is the first true laser technology ever for cataracts.

Q: What does a femtosecond laser mean for today's cataract patient?

A: It means no blades and, therefore, no cutting. It creates an astigmatism incision, going a precise depth and length but not opening the skin layer of the eye. So the patient won't have any discomfort.

The laser creates the incision, so it makes the opening for the cataract, divides the cataract up, and makes the astigmatism incisions. No blades are used and none of the incisions were open to the outside world, so it doesn't even have to be done in a sterile environment. It's comfortable. The patients just get numbing drops, may feel a little pressure, see a light show. That's about it.

This laser will allow us to customize a procedure for every patient. We're now doing things that I couldn't do with a blade. I'm doing a trapezoid incision, which will minimize the astigmatism I induce. It will self- seal incisions. I can have a perfectly round opening in that capsule and perfectly centered, and that's important to where the new implant sits in the eye to give people 20/20 vision.

Then they're brought to the operating room. We remove the cataract that's left and put in a new lens.

Q: Besides the precision and the improved vision, what's another benefit of the technology.

A: People are of the belief that they will have to refrain from activities, have someone at home, and that they will have pain. For patients today, once they have the surgery, they can go to lunch, the movies, play bridge and maybe even play golf later in the afternoon.

Q: Today's cataract patients are a different breed. What do they want?

A: Today's cataract patients want to have the same benefits as LASIK. They want to see better without glasses.

Just 10 years ago, you wouldn't hear someone expecting to see a golf ball 250 yards away. It was just assumed it was part of growing old. The cool thing is we can deliver that now. Our 20/20 rates are where they were with LASIK five years ago.

People today want to be able to see better and do more without glasses. People are living longer and leading more active lives, and they want the same benefits and quality of life without glasses or contacts.

Q: Is this a phenomena related to the baby boom?

A: The baby boomers are just hitting the cataract realm. They are very motivated. A lot of them have already had LASIK surgery. Now they are developing cataracts. They've already had the expense to see without glasses. Plus, we can give multifocal vision: both near and far vision. It's very exciting.

Q: OK, have to ask: Does insurance cover it? And if not, what's the out-of-pocket cost?

A: Insurance will pay to have cataracts removed and to fit people for glasses, but does not cover the laser surgery. But these days, 30 percent to 50 percent of patients say it's OK to pay extra. The majority of the expense is covered by insurance. The extra cost runs about $1,500 to $3,000 out of pocket.

Q: Where do you see it going?

A: Five years, maybe longer or maybe less, everyone will have laser technology for cataracts. The fact that it's here, I think, is due to the foresight and commitment to Physicians' Eye Surgery Center and to my partners at Carolina Eye Care. My partners and associates are committed to new technology.

This is a totally new era. Five years ago, I never imagined we'd be here today with this. I can't imagine where we'll be five years from now. We're now working on lenses that will change shape and move inside an eye so they can see at all distances.

It's an exciting, great time. And it's fun.

What is a cataract?

Light entering the eye passes through its lens. The lens focuses that light on the retina at the back of the eye. A cataract is a clouding of the eye's lens. A clouded lens interferes with how light passes through it, in much the same way that fingerprints or smears on a window interfere with your view of what is on the other side of the glass. Some people with cataracts have described their vision as "looking at the world through waxed paper."

Femtosecond lasers

In the early days of cataract surgery, patients would have to limit their activity for four to eight weeks, and they still needed glasses. About 20 years ago, ultrasound technology was introduced, and cataract procedures became much more efficient and safer. Plus, the recovery time was shortened to just a few days.

FDA-approved femtosecond lasers are considered the first major advancement in cataract correction in 20 years. Femtosecond lasers use the same technology that is used to perform LASIK procedures. The blade-free lasers make more precise and consistent incisions via image-guided surgeon control.

The lasers enable surgeons to plan and customize each procedure based on patient anatomy. The lasers break the cataract into smaller pieces that are then removed using the ultrasound.

Cataract FYI

Cataract correction is the most commonly performed surgical procedure in the United States, with more than 3 million surgeries each year.

Cataracts affect more than 22 million Americans ages 40 and older according to AllAboutVision.com. The website also says that more than 30 million people are expected to have cataracts by the year 2020.