Durban - Cataract surgery is in demand and one of the most commonly performed procedures in South Africa.
While it is considered one of the safest operations, the advent of laser treatment appears to have made it even more precise and time efficient.
Dr Jean-Henri Le Roux, an opthomologist at Hillcrest Private Hospital, which has introduced a femtosecond laser, says it is an exciting new addition for KwaZulu-Natal, improves accuracy and reduces the risk of infection.
A cataract is a cloudy area in the lens of the eye that often impairs vision.
It may also be blurry, foggy, or filmy, and in older people causes progressive nearsightedness called “second sight” because they may no longer need reading glasses. Other symptoms include the way you see colour, problems with glare and double vision.
It may come with age, be congenital (in babies as a result of poor development, injury or infection), secondary (as a result of diabetes) or as a result of trauma.
Your doctor is likely to first try to correct the problem with change in prescription eyeglasses, including bifocals or contacts.
If the loss of vision cannot be corrected with new glasses and interferes with your daily life, you may be a candidate for cataract surgery, which involves removing the clouded lens and replacing it with a clear, artificial one.
In traditional cataract surgery, the eye surgeon uses a hand-held metal or diamond blade to create an incision in the peripheral part of the cornea (where the glass-like dome of the eye meets the white sclera).
The goal in creating this incision is to go a partial depth vertically, then horizontally in the cornea and then the eye. The surgeon then breaks up and removes the cataract, which is located behind the pupil. Next, an intraocular lens is implanted, to replace the natural lens.
The reason cataract incisions are created in a two- or three-plane fashion is so they will self-seal, allowing for a no-stitch approach.
The capsule the natural lens sat in, which is as thin as cellophane wrap, must be left undamaged so that it can hold the artificial lens implant in the proper position for the best ability to focus.
On the other hand, the femtosecond laser is used by the surgeon to create a precise surgical plan with a sophisticated 3D image of the eye called an OCT (optical coherence tomography).
Set correctly, the femtosecond laser creates an incision with a specific location, depth and length in all planes, without the variable of a surgeon’s experience.
This is important not only for accuracy, but to ensure that the incision will be self-sealing at the end of the procedure, which reduces the risk of infection.
Apart from human error the laser also affects the way in which the cataract is removed.
The laser uses less energy to soften the cataract for removal, reducing the chance of burning and distorting of the incision.
The reduced energy of the laser may also make the procedure safer to the inner eye, which reduces the chance of certain complications, such as a detached retina.
Le Roux says, “Due to the extreme precision of the laser, not only is the incision perfectly round, it is the exact size, in the exact position and with minimal stress to the eye. The key benefit is that cataract surgery is now even safer. This latest technology has made an excellent operation into a near perfect one.
“The accuracy and precision of the laser enables the surgeon, with the assistance of a high-performance computer, to plan and direct all laser incisions with perfect accuracy.”
Dr Bill Nortje, another ophthalmologist using the technology, says, “This state-of-the art laser has replaced the manual steps that the surgeon performs, using advanced physics and technology to determine the exact position and shape of the individual patient’s eye. Based on these measurements the laser machine is able to customise the incision for each individual patient. When the time comes for me to have cataract surgery, this is the machine that will do it.”
The Mercury