Laser Lens Replacement
Laser Lens Replacement is also known by other terms such as Natural Lens Replacement and Refractive Lens Exchange (RLE). In an attempt to "demedicalise" the procedure, brand names such as Clarivu™ or NuVu have been used. The process of Laser Lens Replacement involves removal of the natural lens inside the eye with a high performance lens implant which corrects vision.Trifocal lenses and "Extended Depth of Focus" (EDOF) lenses provide the majority with independence from glasses altogether. New developments such as the Victus femtosecond introduced to the UK by Centre for Sight in 2012 improves procedure safety and outcome by adding a whole new level of precision. With almost 3000 laser lens replacement procedures, Centre for Sight is amongst the most experienced centres providing Laser Lens Replacement or Refractive Lens Exchange
Laser Lens Replacement / Exchange
This simple Day Case operation similar to cataract surgery is the most common surgical procedure performed in the world. The aim of the surgeon is to provide spectacle independence and to accomlish this a phenomenal level of accuracy is required. The procedure is performed by Microincisional surgery (1.8mm at Centre for Sight) and ALL patients are treated using the Victus femtosecond laser - no compromise !
Why Lens Replacement ?
The natural lens in the eye becomes harder with advancing age and in turn fails to change shape adequately to alter focus for near. A change in shape is necessary when looking at near objects e.g. reading a book or ipad. The natural lens functions inadequately and the condition is termed by some as "Dysfunctional Lens Syndrome" (DLS). This lens becomes progressively harder and in turn near focus deteriorates further with advancing age. Reading glasses which become progressively stronger are needed to be able to see. This condition is also called Presbyopia.
In the interests of transparency and to avoid misleading our patients, at Centre for Sight we as doctors prefer to use commonly used medical terminology rather than confusing brand names such as Clarivu and NuVu.
“Replacement of the poorly functioning natural lens with a high performance lens implant can result in complete spectacle independence!”
Lasers replace the Human hand.
Medical Lasers are known to be highly precise improving the safety of surgery as well as predictability by decreasing the number of variables. The Victus Laser for Cataract performs absolutely perfect, repeatable and reliable surgery with accuracy to 1/1000th of a millimeter. With perfection at this level, lens surgery has to the benefit of doctors and patients become even safer and more predictable.
In summary all the following components of surgery previously performed by a steady hand are now performed by the laser and reproducible from eye to eye:
- Micro-incisions are made in the eye with the laser and these can be constructed to be watertight.
- Perfect round opening in the cataract capsule allowing access for removal.
- Fragmentation / destruction of the cataract bulk and very useful in those with hard cataracts.
- Limbal Relaxing Incisions to correct astigmatism.
The laser provides online cross sectional microscopic imaging (OCT scan),very much like an online MRI which is used to guide location of the laser treatment within the eye with considerable accuracy.
Centre for Sight installed the world's 3rd commercial Victus laser in April 2012. Centre for Sight is a reference site for the manufacturing industry (Technolas Perfect Vision / Bausch and Lomb). Visitors from the United States, Canada and Europe regularly visit the Centre to see Victus in action and to observe our unique manner of delivering the femtosecond laser procedure.
Innovation - New device 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. Studying this further a review of notes and data analysis revealed a statistically significant reduction in time required to remove the cataract. Quicker removal is obviously safer for the eye as there is reduced time for bacteria to gain access. The technique called “Translenticular Hydrodissection” by Sheraz Daya which has received great acclaim by international surgeons was presented at the European Society of Cataract Surgery, Milan 2012 and American Society of Cataract and Refractive Surgery (ASCRS) Chicago 2013. The video demonstrating the technique won an "Oscar" at the ASCRS film festival in 2013. The technique requires use of a commercially available device. The technique was invented at Centre for Sight and developed in collaboration with the international company 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 Star Trek!
Laser Lens Replacement- The Process
This is considered the most important part of the whole process of care. Good planning is required for all successful projects. At consultation numerous tests are performed using a number of machines and instruments which measure corneal shape, optical aberrometry, the lens thickness and length of the eye. After all tests are completed, a specialist fellowship-trained consultant eye surgeon evaluates your eye and discusses the best available options for you specifically. The choice of procedure and lens implant is based on your age, eye condition, eye health along with your lifestyle and visual needs. Alternatives, benefits and any risks will be discussed. To help understand the procedure and lenses, you will be shown a series of videos.
The Procedure - just beforehand
One eye is treated at a time and the procedure is performed as a Day Case operation. While the procedure only takes 15 minutes, you must be prepared to spend 2 to 3 hours at the Centre . You will be asked to arrive at a paritcular time for surgery. Prior to surgery, further investigations may be required to ensure absolute accuracy of the treatment plan. After your consent form is checked you will receive dilating drops to expand your pupil so that the surgeon can have access to your lens. The surgeon may need to place a removable mark on 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 and will in all probability hardly remember anything about the operation.
In the Operating Theatre / Room
A small IV cannula may be placed in one of your arms to allow the anaesthetist to provide intravenous sedation. Alternatively you may recieve an oral sedative tablet to reduce any anxiety. You will be wheeled into the theatre and then have to sit up and then lie on the bed of the Victus laser. You will receive more drops after which your surgeon will peform a series of pre-operative protocols or "flight checks" with the operating theatre team. A suction ring will be placed on the eye and will deliver a sense of pressure. This ring connects to the laser. During this process it will be necessary to hold still. Online scans are performed and a series of measurements in your eye are used to determine where the laser treatment occurs. A beeping sound informs us the laser is in action and during this time the laser will create a perfectly circular opening in your lens and also break the lens up into small fragments and when required create incisions to correct astigmatism.
After the laser treatment, you will then step back into the operating bed and the Surgeon will continue to remove the fragmented lens and implant an intraocular lens. Often patients report seeing a series of colours and flashing lights - enjoy the show! After the procedure has been completed the Surgeon will inject antibiotics into the eye to prevent infection. A patch and eye shields placed on the eye and removed the next day.
You will have some time to recover following surgery and when ready you will be served a light snack. You will be given a small toiletry bag containing 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 following day, you should take off your shield and patch. Preserve the shield in case you are instructed to use this at bedtime. Commence your drops as instructed remembering to close your eyes for 5 minutes by the clock before adding the next drop. You may have an appointment to be seen that day or a day or two later. If you are not seen the next day, someone from Centre for Sight will contact you to ensure you are making good progress.
The good news is visual recovery is typically very quick with many patients obtaining excellent vision the day following surgery. Sometimes vision is blurred for one or two days for a variety of reasons and this might be the case if the cataract was particularly hard. A high performance lens like a trifocal lens implant provides the ability to read without glasses. A monofocal lens corrected for distance vision often results in poor near vision easily remedied by a temporary pair of off the shelf reading glasses.