The Latest Advances in Catarats Treatment
As we get older, development of cataracts is virtually inevitable. With time, the lens of the eye becomes increasingly cloudy, forming a cataract which blurs vision and untreated will lead to blindness. There are no drops or non-invasive treatments available to prevent it. To restore vision, cataracts need to be removed and replaced. At present, the only real option for treating cataracts is surgery.
We are currently entering a new era of cataracts treatment with advanced new options becoming available. It is important that patients know all the types of surgery on offer so they can make an informed decision.
Types of Cataract Surgery
The conventional — what’s come to be known as “manual” cataract surgery — is still the most prevalent form of surgery, using ultrasound energy to break the lens. This technology has existed for the past 50 years. And while it has improved in terms of reducing the amount of ultrasound energy used, it has not changed significantly for some time.
It is still difficult to use this technology in some instances such as when the cataract is especially dense and requires more ultrasound to break it down. Some of the ultrasound energy used to break down cataracts can hit other structures in the eye such as the inner lining of the cornea, the corneal endothelium. A significant permanent reduction in the corneal cells can prevent recover of vision and may require a corneal transplant.
Laser cataract surgery has been used over the past 5 years to great effect. Femtosecond Laser Assisted Cataract Surgery (FLACS) enables surgeons to pre-cut the lens to remove the cataract. It limits the risk of complications by using as little as 1–2% of the amount of ultrasound energy otherwise needed with the manual cataract surgery method. This improvement causes less internal trauma to the eye and enables patients to recover faster.
Whereas the traditional ultrasound is only used to break the lens, a laser performs 3 different manoeuvers: breaking down the lens, creating corneal incisions, and cutting the capsule.
“One major reason why the safety of cataract laser surgery techniques came into question is due to a study put forward by Dr Robin Abell and others in 2014,” said Associate Professor Chandra Bala, Ophthalmologist with PersonalEYES and Associate Professor of Ophthalmology at Macquarie University.
Associate Professor Bala maintains that the Abell study, which was written soon after the laser technology became available, assessed only one laser platform which resulted in post-operative complications. Since then, this influential study has negatively influenced the uptake of laser surgery technology by some Ophthalmologists, who may be reluctant to present the laser option to their patients without ever having engaged with the technology themselves.
Associate Professor Bala believes that the Abell study has been taken out of context, especially because other laser platforms have since produced significantly better results without the complications. “This was an indication to us that some lasers are better than others,” he said.
Further, on close examination, Associate Professor Bala and his associates found that the laser beams in the Abell study were directed in incorrect spots — probably due to the movement of the laser over the liquid interface — which likely lead to the complications. Some of the lasers improved with different settings producing excellent smoothness of incisions. Another study from Associate Professor Bala showed no difference between manual and laser techniques, allaying concerns about the laser.
Another recent 2017 study using meta analysis data by Dr Thomas Khonen considered pooled data from more than 9000 studies. The meta analysis study included all the research that covers laser cataract surgery and used specific protocols, carefully sifted through the data to arrive at its conclusions. It clearly finds that the use of laser requires less energy than conventional techniques and that patient recovery is better. The only skew in the meta-analysis data is the information incorporated from the Abell study data.
“The ultrasound ricochets inside the eye and can inadvertently damage corneal cells. If you use less ultrasound energy, you are much gentler on the cornea,” Associate Professor Bala said. “This is an important advance because you want to preserve good healthy tissue for as long as possible.”
“I can categorically say that laser is better. If my own family member needed cataract surgery, I would have no hesitation recommending they have laser surgery”, he added. “It is important to consult Ophthalmology surgeons who are willing to embrace laser technology and make this malleable to their needs.”