What do I need to consider when it comes to Lasik and Cataract Surgery?

Novena Bladeless Cataract Surgery & Eye Specialist Centre offers these services:

1. iLASIK
2. Implantable contact lens
3. Phacoemulsification Cataract surgery
4. Bladeless laser cataract surgery
5. Floaters laser treatment

Screening is important for these conditions:

• Glaucoma
• Cornea Disease
• Macular Degeneration
• Diabetic Eye
• Retina Disease
• Childhood Myopia

Specific Treatments to Consider:

1. iDesign Lasik
2. Presbyopia Correction
3. 100% Bladeless Femtosecond Laser Cataract Surgery; Computer-Guided Intraocular Lens Implants

Some notes on Refractive Error

1. Myopia
2. Hyperopia
3. Astigmatism
4. Presbyopia

• Refractive errors occur when light rays focus on the retina

• Caused by defects

• Cornea power

• Lens power

• Length of eyeball

The Lasik Procedure

Step 1: Creating the Flap with the IntraLase Method

Step 2: Correcting your vision

Am I suitable for Lasik?

• Myopia (up to -12.00D)
• Hypermetropia (range up to +4.00D)
• Astigmatism
• Refractive errors after previous cataract surgery
• Presbyopia

An ideal patient for Lasik

• FDA Approval > 18
• No upper age limit
• Stable refractive error
• Sufficient cornea thickness
• Not pregnant or breastfeeding
• Free of disease of the eye

Lasik Cataract Surgery possible side effects

• Dry Eyes
• Night glares and halos
• Flap Striae
• Epithelial in-growth
• Inflammation
• Infection
• Ectasia

Traditional Vs IntraLase

Traditional

• Uses a microkeratome to create the corneal flap
• Handheld stainless steel device
• Holds a metal blade
• Oscillates back and forth to create a flap

IntraLase

• Uses a laser to create the corneal flap
• Highly advanced computer-controlled technology
• 100% blade-free
• Uses tiny ultra-precise pulse of light to create the corneal flap

Presbyopia “Lao Hua”

Lens and muscles relax when looking far away

Lens and muscles contract for reading fine prints

The 5 zones of human vision

1. Legal text, sewing, microsutures (and 15cm away from the eye)
2. Reading newspaper magazine
3. Intermediate zone - desktop monitor
4. TV, Optometrist chart
5. Far distance, golf, shooting

Age >50 and no cataracts:

Presbyopic correction

• LASIK monovision (enables eye specialist to program all 5 zones so you can be spectacles free)
• Cataract surgery monovision
• Cataract surgery multifocal lens implant

Dr Goh’s Cataract Surgery

What is cataract?

Affects people over 50 years old, we examine the eye with a slightly yellow tip. When we examine, can tell even if they are very young we suggest cataract surgery over LASIK

Causes

• Natural ageing of crystalline lens
• Congenital
• Trauma-Related
• Co-morbidity e.g diabetics
• Iatrogenic

Symptoms

• Blurred vision
• Glare with bright lights
• Double vision or “ghosting”
• Headache
• Refractive errors

We have a machine that grades cataracts (mild to severe)

Types of cataract surgery

• ECCE surgery (long incision and stitches)
• Manual Phacoemulsification surgery (small incision enter cornea, 2.2mm incision then picks up the skin and rotate sharp force that tears the orange skin, and puts in ultrasound probe, cutting up cataract in small pieces, that's done by hand)
• 100% Bladeless Femtosecond Laser surgery

Manual Phacoemulsification Surgery

Scanning a patient's eye, through a monitor we can see the status of the eye before the laser starts. It performs >10000 individual scans to capture huge data using imaging data. Once laser starts perform 2mm incision and after 1.5s a cut on the cornea is made and once again within 1.5s done using the laser)

Custom cataract surgery

1. Monofocal Vs Multifocal lens implant
2. Patients want total spectacle independence
3. Modern cataract surgery is a refractive procedure

Choices of presbyopia correction

• Monofocal IOL

• Multifocal Implant

• Advantages

• Can see at all distance

• Convenience

• Disadvantages

• Night Glares and Halos (temporary)

Preparation for surgery

• Local anaesthesia (GA only for uncooperative patients)
• Physically fit and well
• Stable control of blood pressure and glucose
• ECG
• Urine dipstick test

Postoperative care

• Typical antibiotic and steroid regime 1 month
• Avoid swimming for 4 weeks
• Eyeshield during sleep for the first day
• Avoid polluted environment the first week

Steps in cataract surgery

• Cataract Eye Check

• Biometry for lens implant power

• Pre-assessment of general health

• Cataract Surgery

• Nil by mouth 4 hours prior

• 30 min surgical procedure

• Rest for 30 min before leaving

• Start using eye drops that night

• 3 Reviews after surgery

• Second surgery can be done the next day according to patient