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Health, Beauty & Fashion

Easier on the eye

Doctors can now use the femtosecond laser system to cut up cataract. This method offers several advantages, two surgeons tell Cheah Ui-Hoon.
The Business Times - July 14, 2012
By: Cheah Ui-Hoon
| More
Easier on the eye S\'PORE PIONEER \r\nSince April, Dr Lee has conducted close to 100 cases of femtosecond laser cataract surgery. \'That\'s about 40% of my patients,\' he says. \'The acceptance rate is quite high.\' - PARKWAY EYE CENTRE

LASIK procedures have gone bladeless since 2004, but now, so have cataract operations - promising increased precision and thus, a more accurate positioning and centration of the replacement lens.

The femtosecond laser system, instead of just being able to cut the surface of the eye (for Lasik procedures), is now also able to cut the cataract inside the eye.

"The femtosecond laser has a few advantages to it," explains Lee Hung Ming, medical director of the Parkway Eye Centre at Gleneagles. "Firstly, it allows a perfectly-shaped, sized and well-centred opening to be cut on the cataractous lens. This is opposed to using hand-held forceps to manually make an opening for the procedure.

"Secondly, we use the laser to cut the cataract up into four to six pieces, before ultrasound is applied to break up the density of the cataract for easy removal. This means less ultrasound energy is needed, and this is good for patients with dense cataracts.

"Using the laser for the incision on the cornea means it's also more precise and completely bladeless. Within 45 seconds, the laser will make an opening on the cataract, break the lens, and make a corneal incision for the removal of the cataract."

For the fourth advantage, those with mild astigmatism can have it treated, as the femtosecond laser is capable of making a small cut on the cornea to correct the astigmatism. The entire laser procedure is also video-guided, says Dr Lee, who was the first to perform bladeless cataract surgery in Singapore.

Cataracts are pretty much inevitable in the course of ageing. It is the clouding of the eyes' natural lenses because of ageing, and the most common symptoms are blurring of vision and seeing halos and glares at night, especially when driving in low-light settings. Another symptom is increasing myopia.

Implanting of artificial lens

During cataract surgery, the cloudy natural crystalline lens is removed and an artificial intraocular lens is implanted. In conventional cataract surgery, blade is used for the incision and ultrasound is used to dissolve the cataract, which is then sucked out with a pump.

Dr Lee says that cataract surgery is one of the safest and most successful procedures in the world. "In general, the main disadvantage of bladeless laser cataract surgery is that it costs more," he notes.

MediAid can, however, be used to claim $2,450 of the cost.

At the Singapore National Eye Centre (SNEC), three doctors have started using this technology to treat both straightforward and complicated cataracts.

"We are now embarking on the next phase of training and accrediting other senior doctors in the SNEC within the next couple of weeks," says Chee Soon Phaik, head and senior consultant, cataract service, SNEC.

Most of her cases are done using laser technology, and SNEC has conducted close to 100 to date.

Minimising optical aberrations

The biggest advantage to laser is that it has the ability to create a precise capsule opening that is round, and centred on the intraocular lens implant, says Dr Chee. "That minimises optical aberrations (distortions) of the lens, which is something every surgeon would wish to be able to deliver to his patient."

Those who can't opt for laser are patients with a poorly dilating pupil, dense corneal scars and advanced glaucoma.

Even though the procedure is more expensive, SNEC patients don't pay extra for it.

Dr Chee also points out that intraocular lens technology has improved so much that cataract surgery today can simulate the outcome of refractive surgery such as Lasik. "With highly precise instruments that measure the eyeball parameters necessary to calculate lens power, and by implanting the right corrective lenses, problems like myopia/hyperopia, astigmatism and presbyopia can be corrected."

Generally, those who need cataract surgery will be aged above 60, but there can be those who have it younger - those who have had an injury to the eye, or those who are highly myopic or diabetic.

Since April, Dr Lee has conducted close to 100 cases of femtosecond laser cataract surgery. "That's about 40 per cent of my patients," he says. "The acceptance rate is quite high."

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