Archive for the ‘Cataract Surgery’ Category

Advantages of Using a Laser in Cataract Surgery

Friday, October 7th, 2016

shutterstock_37044946Cataracts are extremely common in older adults. Experts say that one in three people will need to have cataracts removed at some point in their life. Traditionally, the steps of cataract removal surgery were performed with handheld surgical instruments. Today, many cataract surgeons, including the team at Bochner Eye Institute, are incorporating a femtosecond laser into the procedure to perform critical steps of the operation. Laser cataract surgery has been linked to fewer complications and faster recovery of vision.

Here, the Toronto cataract surgeons of Bochner Eye Institute discuss the advantages of laser cataract surgery and what that could mean for the millions of people that need cataract surgery. (more…)

Laser Cataract Surgery: Impressions on the first 250 Eyes treated at Bochner Eye Institute

Friday, October 18th, 2013

Improving Precision, Improving Results

Laser cataract surgery has surpassed my expectations of enhanced precision, accuracy, and safety. I was cautiously optimistic based on reported clinical results in other countries. Over the past six months, I have been impressed by the sophistication of the machine, the ease of use, reproducibility, and patient outcomes. The Catalys Laser System has been an exciting and easy procedure for patients to undergo with a quick visual recovery. Patient satisfaction has been extremely high. Here are my initial clinical impressions:

Perfect Capsulotomy

The capsulotomy is computer programmed to be centred over the visual axis with the creation of a perfect circular opening of 5 mm. Although I am comfortable with traditional surgery using forceps to create a capsulotomy, no surgeon can consistently make a perfect 5 mm opening. By creating a precise capsulotomy the residual anterior capsule overlaps the edge of the implant and holds the lens in position. With a less than perfect capsulotomy the implant can be tilted, or vault forward or backward. Laser cataract surgery with a precise capsulotomy results in a more predictable final resting position of the implant, which improves the refractive outcome and results in fewer induced higher-order aberrations.

Elimination or Reduction of Phacoemulsification

The Catalys system using 3-D OCT imaging and a femtosecond laser can fragment the nucleus into tiny cubes, which can then be primarily aspirated. In traditional cataract surgery, phacoemulsification is utilized to break the nucleus into tiny pieces prior to aspiration. This phaco energy from a tip that vibrates very quickly (20,000 times per minute) can cause adverse ocular effects. The ultrasound energy can result in corneal endothelial cell loss as well as a higher incidence of cystoid macular edema. By eliminating or reducing ultrasound energy we can preserve the corneal endothelium and hence corneal clarity, both short-term and long-term, as well as reducing the incidence of cystoid macular edema. My experience in the initial cases treated is that the corneas were clearer one day postop, and there was a quicker recovery in terms of uncorrected visual acuity and best-corrected visual acuity. Eighty percent of the initial cases were performed without phaco energy. Of the twenty percent of cases that required some phaco energy the level was significantly reduced compared to traditional surgery.

Correction of Astigmatism

Femtosecond technology can perform precise arcuate corneal incisions to reduce astigmatism. Using real-time OCT imaging the thickness of the cornea is determined. We can plan arcuate incisions at a 9 mm optical zone and at a depth of 85%. We have the option of opening these incisions at the time of surgery or to do this postoperatively to titrate the effect. We are creating these small incisions in anyone with 0.50 D or more of astigmatism. The outcomes have been significantly more predictable than performing limbal relaxing incisions with a blade. These laser arcuate incisions can be combined with a toric implant for higher degrees of astigmatism. Postoperatively, if necessary, the incisions can be opened to enhance the astigmatism correction.

I hope you find these initial impressions on Laser Cataract Surgery of interest. Please let me know if you would like to see a procedure or desire any further information.

Raymond Stein, MD, FRCSC
Medical Director, Bochner Eye Institute
Associate Professor of Ophthalmology, University of Toronto

About Bochner Eye Institute
Established 1929

The Bochner Eye Institute is a tertiary eye-care facility that was founded by Dr Maxwell Bochner in 1929 and devoted to providing leading-edge technology and excellence in patient care. Our building is a historical house that encompasses 4 floors of clinical activity.The surgeons were among the first in North America to offer laser vision correction, corneal crosslinking, topography-linked PRK for irregular corneas, phakic implants, and laser cataract surgery. The surgeons have written over 35 textbooks and hundreds of scientific articles.

40 Prince Arthur Avenue
Toronto, Ontario M5R 1A9

416 921 2131

www.Bochner.com

“The Official Supporter of the Toronto Maple Leafs”

Toronto Maple Leafs and all related marks and designs are
trademarks and/or copyright of Maple Leaf Sports & Entertainment © 2013. Used under license.

Dr Raymond Stein was invited to speak on the Catalys Precision Laser System at the American Society of Cataract & Refractive Surgery in San Francisco on April 18, 2013.

Wednesday, April 24th, 2013

Dr Stein presented his experience with the Catalys Precision Laser System to over 500 ophthalmologists from around the world at the Mascone convention centre in San Francisco. He spoke on the learning curve of introducing the technology and the safety profile. In reviewing all the technologies he has introduced at the Bochner Eye Institute over the past 20 years the Catalys laser had the easiest learning curve. In the first 40 cases treated, 32 were performed without ultrasound. By reducing or eliminating ultrasound energy there is less intraocular inflammation, and less chance of adversely affecting the corneal endothelium or leading to cystoid macular edema.

Dr Stein noted that Laser cataract surgery has significant clinical advantages especially in patients with Fuchs corneal dystrophy, shallow anterior chambers, dense nuclear cataracts, and weak zonules such as in pseudoexfoliation. In addition by performing an exact capsulotomy of 5 mm there is less chance that the implant will vault forward, be pushed posteriorly, or be tilted. This can result in an improved refractive outcome and quality of vision.

Bochner Eye Institute Offering Laser Cataract Surgery in Toronto

Wednesday, September 12th, 2012

The most significant advance in cataract surgery in the past 50 years has been the development of laser cataract surgery. We are proud to be the first centre in Canada to offer laser cataract surgery with the CatalysTM precision laser system. Laser cataract surgery automates many of the steps that were previously performed manually with a forceps, needle, or blade. The precision of the laser allows for enhanced safety and outcomes.

Bladeless Laser Cataract Surgery has a number of unique advantages over traditional cataract Surgery:

  1. Better self-sealing incisions with less chance of leakage.
    The laser precisely creates all the necessary incisions in the cornea. Unlike with a hand-held blade used in traditional surgery, the laser incisions have a unique architecture and a more precise width that allow them to seal better.Masket S, Saraba M. Femtosecond laser-assisted cataract incisions: architectural stability and reproducibility. J Cat & Refract Surg 2010:36:1048-1051
  2. Improved reduction of astigmatism and enhanced comfort.
    The laser incisions to reduce astigmatism are created at a precise location, length, depth, and angle based on intraoperative imaging using an OCT (optical coherence tomography). An OCT provides higher resolution than an MRI. The incisions are created below the corneal epithelium, which provides enhanced comfort. Limbal relaxing incisions with traditional surgery are performed with a hand-held blade.Kymionis G, Yoo S, Ide T, Culbertson W, Femtosecond-assisted astigmatic keratotomy J Cat & Refract Surg. 2010:35(1):11-13
  3. Potential for better refractive outcome and quality of vision
    The laser can create a perfectly round central opening in the anterior capsule of a specific size. The capsule opening can be centered over the visual axis. The intraocular lens is held in place with the remaining capsule. With a more precise capsule opening there is less chance that the intraocular implant will vault forward, backward, or be tilted. This has been shown to result in better quality of vision with a reduction in higher-order aberrations.Kránitz, K; Takacs, A ; Femtosecond Laser Capsulotomy and Manual Capsulorrhexis and Effects on Intraocular Lens Centration. J Refract Surg. 2011;27(8):558-563.
  4. Potential for clearer vision early postoperatively.

    The laser is used to fragment or break the cataract into small segments before being liquefied with ultrasound and removed with aspiration. The laser fragmentation results in a dramatic reduction in ultrasound energy by approximately 96%. This reduced energy is safer for the long-term health of the corneal endothelial cells and may lead to clearer vision in the early postoperative period.Naranjo-Tackman R. How a femtosceond laser increases safety and precision in cataract surgery. Curr Opin Ophthalmol 2010

Laser cataract surgery is a revolutionary cataracts treatment that is safe and precise. The advent of this technology has made it possible for more patients to seek treatment and obtain clear vision, including patients with astigmatism. To learn more about laser cataract surgery or in Toronto, contact Raymond Stein MD at Bochner Eye Institute to schedule a comprehensive consultation with an experienced laser vision correction surgeon.

Dr. Raymond Stein Lectures On New Innovative Treatments

Monday, November 14th, 2011

Dr. Raymond Stein was an invited guest speaker to the Vision Institute’s annual meeting in Toronto on November 4, 2011. The title of his presentation was “The Future of Cataract and Refractive Surgery”. Dr. Stein discussed some of the new innovative treatments such as Laser Cataract Surgery, Corneal Inlays for presbyopia, Corneal cross-linking combined with topographic laser ablations, and Microwave technology for keratoconus. The audience was over 300 eye-care professionals.

Premium Intraocular Implants with Dr. Stein

Thursday, November 19th, 2009

Premium Intraocular Implants

All patients that are to have cataract or refractive lens exchange surgery need to be aware of their implant choices. Dr. Raymond Stein provides all his Toronto patients with detailed information on all the available options. He will tell them if they are, or are not, a candidate for a specific type of lens. The worse scenario is a patient that has surgery with a standard implant and only later discovers from a friend that they could have had a premium lens (multifocal, toric, or aspheric implant). Not all patients will choose a premium lens but it is important that they are aware of their options.

There have been significant advances in multifocal or accommodative implant technology over the past year. The most impressive implant has been the Restor +3 add from Alcon. This implant has consistently provided distance, intermediate, and near vision. In 2004 Dr. Raymond Stein was the first surgeon in Canada to implant the Restor +4 add. This implant provided distance and near vision but intermediate vision was difficult for the majority of patients. The new Restor +3 add represents breakthrough technology. Some patients may have some glare at night but this is typically mild and in a high percentage of cases diminishes over 6 months. For patients that desire a reduced dependency on glasses the Restor +3 add is Dr. Stein’s implant of choice. If patients are not satisfied with their refractive outcome then a refinement can be accomplished with laser vision correction.

Clinical results of the Toric implant from both Alcon and Rayner have been superior over limbal relaxing incisions for astigmatism. For patients with 1 D or greater of preoperative astigmatism the Toric implant is the lens of choice. This implant can be custom ordered to correct up to 6 D of cylinder. The lens is orientated in the eye along the steep meridian. These implants are made of an acrylic material that adheres to the posterior capsule and prevents rotation. Although limbal relaxing incisions are an alternative method for dealing with preoperative astigmatism the results are highly variable as the effectiveness of the incisions are dependent on the biomechanical properties of the cornea.

For patients that are either not candidates or are not interested in a multifocal or toric implant an aspheric implant is an excellent choice. The cornea normally induces positive spherical aberration and the crystalline lens, at least when we are young, balances this by producing negative spherical aberration. As we get older the crystalline lens changes with the net result that patients have positive spherical aberration. This leads to diminished quality of vision especially at night. An aspheric implant will counter the positive spherical aberration of the cornea, which usually results in superior quality of vision.

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The Restor +3 from Alcon – Raymond Stein, MD

Wednesday, April 29th, 2009

Please read below as Dr. Raymond Stein talks more about the Restor +3 add:

There have been significant advances in cataract surgery implants in the past year. The most impressive bifocal implant has been the Restor +3 add from Alcon. The implant has consistently provided distance, intermediate, and near vision.  In 2004 I was the first surgeon in Canada to implant the Restor +4 add. This implant provided distance and near vision but intermediate vision was difficult for the majority of patients. The new Restor +3 add represents breakthrough technology. Some patients may have some glare at night but this is usually minimal and in my experience not of clinical concern.  All cataract and refractive lens exchange patients need to be aware of their implant choices.  For patients that desire a reduced dependency on glasses the Restor +3 add is my implant of choice.

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