Cataract surgery is the most commonly performed surgical procedure in the world. However, the focus has now shifted from a purely vision restoration to a refractive procedure. Advancements in technology have led to the evolution of Laser Refractive Cataract Surgery, which offers with it an extreme degree of precision and accuracy.
During the past 50 years, we saw the following advances in cataract eye surgery:
Femtosecond Lasers use ultrashort pulses of near infrared laser light to disrupt the tissue. Guided by optical coherence tomography (OCT), the platform creates a 3D imaging of the eye. With this information, the surgeon can plan the procedure. Once final checks are made, the laser is started, automating the first four steps of cataract surgery, the whole sequence needing less than 60 seconds.
Laser technology replaces the first four essential steps of cataract surgery.
The laser is used to make the corneal incisions. This first step in cataract operation has, to date, been performed manually using a diamond or a metal blade. Unlike a blade, when using the laser refractive cataract surgery technique, the image guided, computer-controlled laser can be programmed to make a precise cut with a shape not achievable mechanically. The shape, length and width can all be programmed with the laser. This reduces the incidence of variations in the surgical wound that can lead to operative complications. It adds to wound integrity and further improves the visual outcome with reduction of surgically induced astigmatism.
A laser-cut capsulotomy: The lens of the eye is surrounded by a capsule – the laser creates a perfectly round opening in this capsule allowing access for removal and replacement of the lens. The size and position can be accurately selected, the ideal sized overlap which has been understood to be critical for optimal positioning of the intraocular lens. Performing this delicate, intricate step with laser technology has been shown to provide better visual outcomes.
Breaking up of the hard lens. Traditionally, the lens is separated from the capsular bag and cut into fragments using ultrasound power with the phacoemulsification probe. The high energy of ultrasound, if improperly used, can pose a risk for complications, including tearing the capsular bag and injuring the delicate zonular fibres that hold the bag in place. The integrity of these zonular fibres is crucial for a successful surgical outcome. Laser refractive cataract surgery reduces the risk of damaging either the capsular bag or the zonular fibres, with the laser gently breaking apart the hard lens, image guided with precise placement of the cuts in the cataractous lens. The fragments can then be removed using significantly reduced (by approximately 50%) ultrasonic power which ensures protection for the different components of the eye. Arcuate-IncisionsArcuate IncisionsFurther, arcuate incisions can be fashioned on the cornea with the laser which corrects the astigmatism and further improves the visual outcomes. Once the laser procedure has been performed, the surgery continues in the operating theatre, where the natural lens, separated into fragments by the laser are removed and the synthetic intraocular lens of precalculated power is inserted into the capsular bag.
The move to constantly enhance surgical performance to the highest levels of precision is a constant endeavor and with this intent we at The Eye Foundation, have moved to embrace Laser Refractive Cataract Surgery.