Archive for the ‘Laser 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.

Laser Cataract Surgery using the Catalys Precision Laser System:

Monday, May 20th, 2013

Laser Cataract Surgery using the Catalys Precision Laser System:
Impressions on the first 80 patients treated at Bochner Eye Institute

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 four months, I have been impressed by the sophistication of the machine, the ease of use, the 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:

1.    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.

2.    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.

3.    Correction or reduction 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 80%. 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 more than 0.50 D 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. I am delighted to be able to offer this advanced technology at the Bochner Eye Institute. Learn more about Dr Raymond Stein

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.