Improving Visual Outcomes In Cataract Surgery

Dr Leonard Ang
Medical Director & Senior Consultant Ophthalmologist
Lang Eye Centre

Published in Living Well, The Straits Times, Sept 28 2022

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Improving Visual Outcomes In Cataract Surgery Through Advances in Intraocular Lens Technology and Computer-Assisted Surgery

Cataract is the commonest cause of blindness in the world. Cataract is a condition in which the natural clear lens of the eye becomes cloudy and reduces the amount of light entering the eye. In Singapore, more than 30% of people above 45 years of age and 90% above 60 years of age have cataracts.

Cataract results in gradual and progressive blurring of vision for distant and near vision. The symptoms progress very gradually and people usually do not realise they have cataracts till it is very advanced. Many end up undergoing cataract surgery when the disease is severe, which is not ideal.

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Modern cataract surgery can be safe and the recovery can be fast

Cataract surgery has advanced significantly over the past two decades. Cataract surgery is recommended when the cataract is impairing vision and affecting one's daily activities. Modern cataract surgery can be safe and effective, and the recovery is fast. Hence, it is not necessary to wait for cataracts to be severe before performing surgery.

Cataract surgery usually takes less than 20 minutes to complete. The modern method of removing a cataract is by phacoemulsification. Phacoemulsification involves making a small 2mm corneal incision. Bladeless laser-assisted cataract surgery makes use of a laser to aid in the initial stages of cataract surgery. The cataract is then softened and removed, and an artificial lens is implanted. The wound seals without the need for stitches. There is minimal discomfort after surgery. The recovery is relatively fast and patients can resume their regular activities within a few days of the surgery.

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New and improved intraocular lenses

‍Newer and more advanced intraocular lenses enable patients to see better after surgery. The lens choice may be personalized to correct all refractive errors of the eye, such as myopia (shortsightedness), astigmatism and presbyopia, thereby reducing the need for spectacles. These improved lenses are designed to give patients sharper day and night vision. Monofocal lenses can give patients good distance vision but patients would still require reading spectacles. Toric lenses are able to reduce astigmatism in the eye.

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Multifocal lenses to reduce spectacle use

‍For patients who wish to correct their distance vision and presbyopia (difficulty reading), they can opt for multifocal lenses. Multifocal lenses can reduce the need for spectacles and give patients greater convenience. Newer trifocal lenses are able to correct distance, intermediate and near vision so that patients are able to carry out most of their regular activities without spectacles, including the use of computers with intermediate vision.

Blue light filtering intraocular lenses which reduce short-wave-length light reaching the retina, may help to reduce the risk of developing AMD. It may also help to improve the sharpness and contrast sensitivity, as well as reduce glare.

It is important for the patient to consult an experienced doctor to assess and determine which type of lens is most suited for the patient.

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Improving outcomes with Computer-assisted cataract surgery

The accuracy of surgery may be further enhanced with precision computer assisted image-guided systems. High-resolution digital images of the eye captured prior to surgery can be transferred to the operating theatre to guide surgeons during surgery as computer-generated overlays.

This is particularly useful for lens positioning of multifocal lens implants and for the correction of astigmatism with toric lenses. This allows for more accurate incisions and lens positioning so that the surgery is more customized and precise, thereby achieving better visual outcomes.

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Cataract surgery can be safe and effective

Advances in cataract surgery have made the surgery safe and effective, in the hands of a good surgeon. Patients are able to enjoy better vision and better quality of life. New and improved intraocular lenses can help to reduce the need for spectacles and give patients better vision. Computer-assisted image guided systems may further improve the accuracy and precision of cataract surgery.

With modern cataract surgery, patients need not wait for cataracts to become very severe before opting for surgery. Eye screening with an eye specialist for those above 45 years of age can help to pick up cataract as well as other potentially blinding eye conditions earlier, so that treatment can be instituted earlier to prevent visual loss.