Where does the latest laser surgery fit?
Modern Cataract surgery is one of the safest, most accurate and most effective surgical procedures available today. Most Australians will eventually develop a cataract with blurring of vision and a decrease in their quality of life. Today’s microsurgery cataract operation will both remove the blurring and commonly allows the correction of the distance vision without glasses.
Every year over 16 million cataract operations are performed worldwide, 190,000 of which are carried out in Australia
The 20th century saw advances in local anaesthesia and in surgical techniques. These included the introduction of implant lenses, the introduction of small incision surgery for cataract, suture less cataract surgery and ultrasonic phacoemulsification of the cataractous lens.
This has brought us to a painless, efficient, safe and accurate operation performed as day surgery.
The 21st century will see advances in the accuracy of our incision placements and a reduction in the ultrasonic power required to remove the cataractous lens. One early step in this direction is the introduction of the “LenSx” machine which uses femtosecond laser technology to create the initial incisions, open lens capsule and divide the lens into segments.
The rest of the procedure continues under ultrasonic phacoemulsification to remove the cataract and subsequently to implant the intraocular lens (IOL).
“LenSx” is a small and evolutionary step in the advances in cataract surgery we have seen over the last 50 years. It is a foretaste of what is to come and is a genuine step forward.
The “LenSx” laser performs the incision and capsulorhexis at the beginning of a cataract procedure. It may divide the crystalline lens to some extent in the very easiest of cases but this will vary greatly from eye to eye.
The laser is used to start a cataract operation but a cataract still needs to be removed from the eye using existing technologies i.e. ultrasonic phacoemulsification and aspiration.
It is a misconception that the laser will remove a cataract. An IOL still needs to be implanted in exactly the same way it is done presently.
While the word ‘laser’ sounds like it makes a cataract operation safer, the reality is that the same care needs to be exercised with operations started with such a laser as with existing techniques. This is because the crucial part, extraction of the cataractous lens, is no different.
The public can be reassured to know that the present technique of cataract removal, through a tiny (microscopic) incision using phacoemulsification, followed by implantation of artificial IOL, remains the standard of care and is extremely efficient and safe.
As new technology, there is no strong evidence that femtosecond laser surgery will be any safer yet it adds considerably to the cost of the procedure and prolongs the procedure.
If a person has been advised that they have a cataract they should consult an ophthalmologist to determine if cataract surgery is required.
Lasers are routinely used in eye surgery and have been used to supplement conventional cataract surgery to enhance results for several years. This technology is widely available.
Laser technology has been in use in other forms of eye surgery for many years and this represents a new application of the existing technology. It is used to initiate a cataract operation but does not change the method of removal of a cataractous lens.
Existing techniques of cataract removal are extremely safe and effective. This has contributed to making cataract surgery one of the most effective, safe, commonly performed and highly successful procedures performed in the world of medicine.
We should be proud that Australian ophthalmology is amongst the best in the world.
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