Laser cataract Surgery (Femtocataract)

What is a laser cataract surgery?

The laser cataract surgery, also called laser-assisted cataract surgery or femtocataract, is an advanced type of cataract surgery that uses femtosecond  laser technology for a new level of accuracy to specific steps in cataract surgery that would have otherwise been performed manually by conventional surgical instruments and blades.

These steps include:

  • Creation of the corneal incision
  • Removal of the front capsule
  • Fragmentation and replacement of the lens.
    In this article, we will discuss in more details the process of cataract development, its impact on vision and treatment options available. 

What is cataract?

Cataracts are one of the most common ophthalmological diseases , especially for the
elderly population. Normally clear lens proteins precipitate and become less soluble and opaque resulting in blurry vision and haloes. This  prevents the  regular refraction of light rays entering the eye that reach the  retina. Thus,  the image created on the retina and in turn the electrical impulses reaching the brain through the optic nerve are distorted, resulting in blurred vision. 

Except in traumatic cases, cataracts are usually a slowly progressive and chronic process , so initially the patient sees clearly, and the blurring becomes gradually progressive until it starts interfering with daily activities and impacting the quality of life.  It may start in one eye, but eventually it affects both eyes although asymmetrically.

What causes cataracts?

Our lenses are just like the camera lens in terms of functions as they focus light on the retina for clear vision and in addition they adjust the focus of the
eye allowing us to see clearly.
The lens of the eye consists of a precise amount of  water and a set of regularly arranged highly structured  transparent proteins, that  allow light to pass through it at a precise angle to focus on a single spot on the retina for the clearest vision.  
But as we age, and for other pathological reasons, some proteins may cluster together and begin to pull in water molecules into the lens , and over time this increases the size and opacity of the lens, causing blurry vision.
There’s no obvious reason why proteins accumulate on the lens of the eye, but scientists have pointed out that there are some factors that could cause cataracts to develop.

The most common of these  factors are:

  • Excessive exposure to ultraviolet radiation
  • Diabetes
  • Hypertension
  • Obesity
  • Smoking
  • Prolonged use of corticosteroids and other medications
  • Previous eye injury or inflammation
  • Previous history of eye disease or operation
  • Hormone replacement therapy
  • Alcohol intake
  • Severe myopia
  • Family History of cataracts

What are the most common symptoms of cataracts?

  • Initially,  the early stages of cataracts have little effect on your vision.  the type  density and distribution of the cataract will determine the type and severity symptoms you experience and how they occur.
  • You may notice that your vision is not completely clear, such as looking through ground glass, or fog. 
  • Cataracts may make the light from the sun or lamp glowor you may notice when driving at night that incoming  headlights cause more glare than before and the colors may become desaturated and  not as bright as they used to be.

Other symptoms that affect vision are:

  • Blurry vision is the most common symptom.
  • Double vision
  • myopia nearsightedness for the elderly especially
  • Changes in glasses prescription.

Types of cataracts 

  • Cataracts, which affect the central part of the lens, may initially cause temporary visual impairment that can improve with eyeglasses. Over time, the
    lens gradually turns to dense yellow and the vision becomes more blurry. 
  • Cataracts that affect the edges of the lens, this type begins in the form of white lines at the edges of the lens. Eventually these lines overlap and interfere with the  light entering through the lens causing scattering of light in the eye ,and image distortion.
  • Posterior located cataract: it  begins in a small area close to the central part of the posterior layer of the lens,  directly located in the path of light. This type develops faster than the others, and has a more severe impact on vision than the other types
  • Congenital cataracts are linked to a multitude of genetic hereditary disorders and to numerous maternal diseases during pregnancy.

Diagnosis of cataracts:

To diagnose cataracts, your doctor will take a full medical history and follow up on your symptoms by performing a thorough eye exam., which may include  several tests.

These tests include:

  • The visual acuity test, this test measures your ability to read some letters of varying sizes, displayed at a specific. Each eye is tested individually, where the  other eye is covered, through which the doctor determines the strength of your sight and ability to see colors.
  • Slit  lamp examination which uses a slit shaped line of light to illuminate the cornea, iris, lens and other structures in the eye. In the addition,  distance between the cornea and the iris can be measured, allowing the doctor to detect any abnormalities.
  • Detailed examination of the retina through the slit lamp after instilling  special eyedrops to widen the pupil of the eye, which allows the doctor to see into the eye, making it easier to detect cataracts

Cataract  treatment

Cataract is a very common disease and can  be treated with a simple process to replace the affected opacified lens with an artificial transparent lens
It is also possible to perform cataract surgery utilizing femtosecond laser technology. This process is one of the latest high tech modalities in the treatment of cataract.

Is it possible to treat cataract in the eye without surgery?

At present, scientists and researchers are working to find a non surgical cure for cataract such as topical eyedrops to dissolve the precipitated protein accumulations, but until now these compounds are still under trials and research. The actual treatment for the final elimination of cataracts is to perform a cataract surgery, whether traditional or femtosecond laser assisted. 

Cataract surgery

The surgery is simple and takes approximately half an hour to 45 minutes and is done under the influence of topical or local anesthetic to avoid feeling any pain, and you will be discharged home on the dame day , in fact a few hours after surgery.

Surgical steps:

The doctor begins by making a small incision in the cornea to gain access to the anterior chamber of the eye, then he starts  to remove the affected opacified  lens and replaces it with another artificial transparent soft single-focus  or multifocal lens. After surgery you will need glasses to perform some daily activities such as reading or other work regardless of the type of lens placed .  

If  both eyes have cataracts.  it is preferable that the two operations are done separately and with a week difference between them  until the first eye recovers

Laser cataract surgery (femtocataract)

  • The laser cataract surgery is done by placing a camera onto the microscope and  ultrasound device on the eyes  to draw a simplified surface map and collected measurements s that your doctor needs  to know about the lens size, position, and configuration. 
  • The detailed images and measurements captured are then sent to a  computer linked to the femtosecond laser machine to be programmed.  The laser is accurately directed to make precise lengths and  depth incisions for the operation, and then opens the anterior lens capsule and starts to fragment the lens substance
  • The ultrasound device divides the lens into parts and absorbs and dissolves the remaining lens matter. then the surgeon places the artificial clear lens in the eye.

What is the difference between conventional cataract surgery and laser assisted surgery?

  • As for recovery after the two operations, both are very similar regarding visual clarity, some patients see clearly after one week while others need about a week
  • The cost of traditional cataract surgery is significantly lower than femtosecond laser assisted one
  • The femtosecond laser surgery  is more precise takes less time.
  • The use of lasers for cataract removal surgery allows for very precise incisions in less time.
  • Femtosecond Laser process provides astigmatism correction more than regular surgery

Correction of astigmatism after the operation

After cataract surgery, and to reduce the need for eyeglasses or reading glasses, astigmatism should be eliminated and almost non-existent.  
Astigmatism is due to the cornea being more curved in one dimension than the other (becoming more oval rather than ball-shaped)
To reduce this astigmatism it is possible to make small partial thickness incisions in the most curved meridian, and with the healing of these incisions,  rounded shape of the cornea is restored which reduces irregular refraction
This procedure can be performed during the laser refractive cataract operation

How can cataract be prevented?

The main cause of cataract that causes the accumulation of proteins on the lens of the eye is yet unknown so there is no specific way to prevent it.
since this disease is very common in the elderly, they should be examined regularly especially if this is common in family history or if they have coexisting ocular or medical conditions such as  diabetes or other diseases that increase the  likelihood of cataract formation. 

 Routine eye exams booked with your trusted ophthalmologist to thoroughly check the eye,  so that any beginnings process of cataract or other disorders in the eye can be detected in a timely fashion, and dealt with appropriately.  you should also stop smoking and take daily vitamins and foods containing antioxidants

At The Optimistic Eye Center, Dr. Ashraf Soliman provides laser cataract treatment, Dr. Ashraf Soliman, an eye consultant specializing in corneal, cataract and glaucoma surgery and laser refractive  correction in Egypt. He is also an associate professor of ophthalmology at Ain Shams University, faculty of medicine, and consultant for corneal and cataract and glaucoma surgery and laser refractive correction vision defects in Egypt.

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