Laser Cataract Surgery
Cataract surgery is the most commonly performed surgical procedure world-wide. Cataract surgery has evolved considerably in the last 50 years especially in the last few years with the introduction of the Victus Femtosecond Laser and now CAPSULaser. The FIRST Victus Femtosecond Laser was introduced to the UK by Centre for Sight in 2012 and more recently another laser CAPSULaser. The laser used for Laser Refractive Lens Replacement (natural lens replacement) and Cataract Surgery takes the precision and safety of surgery to a completely new level.
Cataract surgery is performed as a Day Case operation and is the most common surgical procedure performed in the world1. In the UK 400,000 procedures are performed a year. The procedure is performed through microincisions (1.8mm at Centre for Sight) and all patients are treated using a laser to perform a critical portion of the procedure – no compromise!
Laser Cataract Surgery
The use of a laser in cataract surgery takes safety and precision of surgery to a completely new level. Victus Laser and CAPSULaser performs perfect, repeatable and reliable surgery with considerable accuracy with a round and complete opening in the lens capsule, a critical component of the procedure. With this level of perfection, cataract/lens surgery has become even safer and more predictable. Combined with high performance implants, those with cataracts can look forward to elimination of glasses altogether!*
Natural Lens Replacement also known as Laser Lens Replacement and branded by some as Clarivu™ or NuVu is a process where the natural lens of the eye is replaced with a high performance lens implant to correct vision. Use of these lenses such as the Trifocal lens, provides patients with spectacle independence*.
*Note those who have Diabetes are not suitable for Trifocal lenses. The choice of lens is limited to monofocal lens implants, Accommodative Crystalens or the WIOL-CF extended depth of focus lens. Your consultant at Centre for Sight will discuss these options in more detail with you at consultation.
“Those with cataracts can look forward to elimination of glasses altogether!”
In summary all the following previously performed by a steady hand are now performed by the laser and reproducible from eye to eye:
- Microscopic laser made Incisions in the eye (rather than scalpels)
- A perfect circular opening in the cataract capsule
- Fragmentation / destruction of the cataract
- Incisions to correct astigmatism
To further enhance accuracy, online cross sectional microscopic imaging (OCT scan), a bit like an online MRI scan is used and guides the surgeon during the 30 second procedure!
Lasers replace the Human hand.
The world’s 3rd Victus laser was installed at Centre for Sight in April 2012. Centre for Sight is a reference site for the manufacturers of laser cataraxct surgery (Technolas Perfect Vision / Bausch and Lomb and CAPSULaser, Excellens). Visitors from the United States, Canada and Europe regularly visit the Centre to see 21st century cataract surgery in action and observe the unique manner in which we deliver the procedure.
Innovative technique and new instrument invented at Centre for Sight!
“Quicker removal is safer for the eye…”
Surgeons at Centre for Sight devised an innovative method of lens removal using the Victus Femtosecond Laser demonstrating a statistically significant reduction in time taken to remove the cataract. Quicker removal is safer for the eye and causes less trauma and eye reaction. The technique named by Sheraz Daya the inventor is called “Translenticular Hydrodissection”3 was presented at the European Society of Cataract Surgery, Milan 2012 and American Society of Cataract and Refractive Surgery (ASCRS) Chicago 2013 has received great acclaim by international surgeons. The video demonstrating the technique won an “Oscar” at the ASCRS film festival in 2013. The technique requires use of a device invented at Centre for Sight and developed in collaboration with Bausch + Lomb. The “Daya Trans-Lens Hydrodissection Cannula” is now commercially available from Bausch and Lomb.
Use of all these lasers makes the operating theatre look like a scene out of Star Trek!
Laser Cataract Surgery – The Process
Usually one eye is treated at a time. The procedure is performed as a Day Case operation and while the procedure only takes 15 minutes, prepare to spend 2 to 3 hours at the Centre. You will be instructed when to arrive at the centre. On arrival a series of checks will be conducted. Further investigations may be required to ensure absolute accuracy of the treatment plan. Your consent form will be checked and you will then receive dilating drops to expand your pupil so that the surgeon can have access to your cataract. The Surgeon may need to mark your eye before the actual procedure to ensure accurate placement of laser astigmatic limbal relaxing or a toric (astigmatic) lens. You will receive strong anaesthetic and antibiotic drops.
In the Operating Theatre
You may have a small IV cannula placed so that the anaesthetist can give you intravenous sedation or you may receive an oral sedative. You will be wheeled into the theatre and then have to lie on the bed of the Victus laser. More drops will be instilled and the surgeon will perform a series of pre-operative “flight checks” with the operating team. You will feel a little pressure of the suction ring that connects to the laser. You must hold still during this process where an online scan checks a series of measurements in your eye and determines where the laser treatment takes place. A beeping sound indicates the laser in action. The laser will create a perfectly circular opening in your lens, break the lens up into small fragments and if necessary create incisions to correct your astigmatism.
Once the laser treatment is complete, you will then step back onto the operating bed and the Surgeon will continue to remove the fragmented cataract and implant an intraocular lens. You will probably see a series of colours and flashing lights – enjoy the show! Once the procedure is complete, the Surgeon will inject antibiotic medication into the eye and ensure the eye is well sealed. You will have a patch and an eye shield placed on your eye. This will be removed the next day.
After the procedure you will have some time to recover and then have a cup of tea or coffee and some sandwiches. You will be given a toiletry bag with your medications and instructions on their use. You will then be able to go home and we suggest you get plenty of rest that day. The next day, take off your shield and patch. Preserve the shield in case you are instructed to use this at bedtime. Commence your drops as instructed. You may have an appointment to be seen that day. If not someone will contact you from Centre for Sight to ensure you are making good progress.
Visual recovery is often very rapid with patients obtaining excellent vision the day following surgery. Sometimes vision is blurred for one or two days and this might be the case if the cataract was particularly hard. If you have had a high performance lens like a trifocal lens implant, then you will find that you will be able to read. If you have had a monofocal lens, then you might need to get a temporary pair of off the shelf reading glasses.
1. Adult Cataract Surgery from the Royal College of Ophthalmologists. NICE Accredited. Revised January 2018. RCophth
2. Wu BM, Williams GP, Tan A, Mehta JS. A Comparison of Different Operating Systems for Femtosecond Lasers in Cataract Surgery. Journal of Ophthalmology. 2015;2015:616478. doi:10.1155/2015/616478. PMC
3. Daya SM, Nanavaty MA, Espinosa-Lagana MM. Translenticular hydrodissection, lens fragmentation, and influence on ultrasound power in femtosecond laser-assisted cataract surgery and refractive lens exchange. Journal of Cataract and Refractive Surgery. 2014 Jan;40(1):37-43. doi: 10.1016/j.jcrs.2013.07.040. Epub 2013 Nov 22. PubMed
4. National Institute for Health and Care Excellence, Cataracts in adults: management NICE Guideline [NG77], October 2017 NICE
5. GOV.UK. Driving eyesight rules [Internet]. [cited 2014 Feb 14]. GOV.UK
6. Minassian DC, Reidy A. Future Sight Loss UK (2): An epidemiologic and economic model for sight loss in the decade 2010-20. [Internet]. [cited 2014 Jan 6]. RNIB