Cataract surgery undergoes a revolutionary change once again

Cataract surgery technique has now changed after two decades of conventional phaco. With the help of the Lensx Femto-second laser and live OCT guided imaging, a surgeon can perform the most challenging steps of cataract surgery with precision and ease. The laser thus provides patients with an absolutely blade-free, highly safe and a better alternative.


Advantages of Femto-Laser

High Precision Unmatched by Human Hands
The laser ushers in a new era of automation, enhancing the skills of the surgeon, making the most difficult steps of Phaco surgery simple and 100% accurate, thereby improving the safety and visual outcomes of cataract surgery. Imagine drawing a round circle with a computer guided printer and a human hand and one can understand the difference.
Blade-less Cataract Surgery
Since the laser is the cutting tool during the entire surgery, no blades or knives are used during the procedure, also earning it the nomenclature of bladeless cataract surgery. A computer controlled laser is a more precise and a better cutting tool than a hand held blade. For people who have a phobia for blades and needles working on such a delicate system as the human eye, this will come as a welcome relief.
Improves vision better than present day surgery
Conventional Phaco only addresses the problem of cataract, without having any impact on the pre-existing astigmatism (cylindrical power) due to abnormal corneal curvature. The femto-laser also corrects the pre-existing cylinder in a patient’s eye, using its astigmatic correction module (LRI) thereby resulting in a better visual outcome as compared to conventional Phaco. 
Henceforth, cataract surgery is not just a procedure for visual rehabilitation, but an experience of enhanced visual outcome.
Safer than present day surgery
Phaco is considered a fairly safe surgery; however, the femto-laser system further enhances the safety by improving the performance of a surgeon, and reducing the chances of human error. The computer controlled incisions made by the laser are more precise and accurate than manual incisions, in terms of depth and architecture, and therefore have better wound sealing and less chances of infections.

A basic platform for Advanced Technology (AT) IOLs

Premium Intra-ocular lenses (IOLs) require a perfectly centered, round and fixed diameter capsular opening for best centering of the lens within the eye, with better focus and improved visual results possible only with Femto-laser.
US –FDA approved
After completing clinical trials, receiving the CE mark, and US FDA approval, the femto-second laser cataract surgery machine is now available in India also. As on August, 2013, there are now 11 such lasers in India.


Limitations of the procedure

The procedure is not advocated in patients with poorly dilating pupils, and in those with advanced glaucoma. It is not the procedure of choice for patients with corneal opacities.


Technique

The Femto-second laser is docked on the eye using a Patient Interface (PI) and a soft specially designed contact lens. Live continuous 3-D OCT pictures are streamed on to the computer screen. Main incision, side port incision and Capsular opening are marked on the computer screen. Astigmatic control incisions if required are also marked. On a press of a button, the laser completes all the steps in approximately 45 seconds. The eye is undocked. The patient shifted to the main OT. The incisions are entered with a spatula. Since no blades are used to make the incisions, the procedure is referred to as the bladeless cataract surgery. The nuclear fragmented material is aspirated out and an IOL inserted. No sutures are required as the incisions are self-sealing.


The Femto-Second Laser Machine

The name of the machine is the LenSx Femtosecond Laser System, being introduced by Alcon, USA. The laser is designed to predictably perform many of the most challenging aspects of traditional cataract surgery.


Cylinder correction in Femto – Bladeless Cataract Surgery

Cataract surgery has now become a refractive surgery and the goal is not just to to remove the opacified cataractous lens but also to reduce dependency on glasses.

A routine Cataract surgery can only correct the spherical component of the eye leaving behind the cylinder power which has to be later corrected by additional prescription glasses.

With advancements in surgical techniques and IOL (artificial lens) designs, today both spherical and cylinder components of eye can easily be corrected with highest precision.

The cylinder component in Femto – Bladeless Cataract Surgery can be corrected by three ways

  1. LRI or Limbal Relaxing Incisions: In this technique, a Femto Laser is used to give highly precise incisions at the periphery of the cornea to induce cylinder correction. Since these incisions are given by a laser, it can only be coupled with a Femto Cataract Surgery.
  2. Toric Lenses with Verion Digital Axis Marking: Toric lenses are special lenses which have both cylinder and spherical component build in one lens. Since cylinder axis varies in individual eyes, the lens has to be aligned to specific axis of the individual. In such cases even a minor deviation from the original axis can cause significant disturbance in final visual outcomes.
    Now with the introduction of Verion Digital Axis Marking system, these toric lenses can be aligned with outmost precision, upto 1 degree.
  3. Toric Lenses with Manual Marking: As discussed above, the final visual outcome in a toric lens depends on how precisely it is aligned to the original cylindrical axis of eye. Since the manual markings cannot be as precise as digital markings, the manual system may give slightly inferior results compared to the digital system.

Above is an attempt to give a broad idea about these three procedures. Different outcomes may be experienced depending upon individual variations. The decision the chose the best procedure rests with your eye doctor after detailed examination of your eye.

IOL Options For Laser Cataract Surgery

Lenses used in Laser Cataract Surgery are premium and highly advanced lenses which require outmost surgical precision to lie in exactly in the optical center of eye. Such kind of accuracy and precision can only be obtained in Laser Cataract surgery.

Aurium are monofocal lenses manufactured by Medennium (USA). These lenses provide excellent vision for distance. In addition these lenses are also photo chromatic, which means they become lightly tinted during day time or bright light and thus prevent harmful UV rays from entering the eye and damaging the retina. Under normal room lighting conditions, these lenses become totally transparent.

Tecnis Symphony is a multifocal lens manufactured by Abott (USA). This lens provides excellent distance and intermediate vision (computer working), however for near work or very fine work one may require additional reading glasses.

Zeiss trifocal lenses are multifocal type lenses manufactured by Zeiss (USA). These are the only lenses which provide excellent vision for near, intermediate and distance.

These lenses have all the properties of Acrysof IQ along with cylinder correctiion capability. An eye can have two types of power–spherical power which is because of the natural lens within the eye and cylinder power which is because of the dissymmetry in the curve of the cornea. A normal lens can only correct the spherical power leaving behind the cylinder power which has to be later corrected by additional prescription glasses. Toric lens corrects both the spherical and cylinder power in the eye. Toric lenses are recommended if you have a high pre-existing cylinder or astigmatism in your eye. This lens is manufactured by Alcon (USA).

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