By Lee Hui Xin Leanne, IECRC

Cataract surgery is the most common major operation performed world-wide. The two most modern cataract surgery techniques are computer-assisted cataract surgery and femtosecond laser-assisted cataract surgery (FLACS).

Dr Joy Chan, Medical Director and Senior Consultant Ophthalmologist at International Eye Cataract Retina Centre, spoke on the topic “Advanced Cataract Surgery and Intraocular Lenses: Giving the Best to Our Patients” during the inaugural Singapore Primary Eye Care Symposium (SPECS) held at One Farrer Hotel & Spa on 11-12 September 2017.

In traditional cataract surgery, also called phacoemulsification, the surgeon creates a small incision in the side of the cornea by hand with a scalpel blade. An ultrasonic probe is inserted into the eye to break up the cataract into small fragments which are then vacuumed out of the eye. Finally, an intraocular lens (IOL) is inserted into the empty lens capsule.

In computer-assisted cataract surgery, a reference image of the blood vessels around the eye is first taken during the preoperative evaluation. This reference image provides visual guides in the surgical microscope during cataract surgery. This allows the surgeon to see the placement of incisions, the exact size, shape and placement of capsulorrhexis and assist in the placement and alignment of the IOL. The usual time-consuming steps of preoperative and intraoperative marking of the corneal surface of the patient’s eye are eliminated, creating a more efficient surgical workflow for the most optimal patient outcome.

FLACS uses a femtosecond laser for increased precision and possibly safety compared to conventional phacoemulsification. The laser is used to create the corneal incisions and to open the lens capsule with very high precision. In addition, the laser assists in breaking up the cataract before an ultrasonic probe is inserted into the eye to complete the lens fragmentation. However, in practice, FLACS is not popular in Singapore as many surgeons have not found the technique superior to phacoemulsification or computer-assisted cataract surgery.

Dr Chan also discussed about new developments in IOLs which are now able to provide patients with improved visual outcomes. This includes bifocal lenses, trifocal lenses and extended range of focus lenses.