What is the best method for cataract surgery?

Doctor's Answer

Photo of Dr Daphne Han
Dr Daphne Han

Ophthalmologist

Femtolaser or conventional cataract surgery is a divide even within the community of cataract surgeons internationally, with surgeons agreeing to disagree. The difference between the two had been described in the previous answers to your question.

Personally I had been performing phacoemulsification with excellent results with and without the femtolaser. The benefit of the laser is that it can reduce the ultrasound energy required in conventional phaco, and it has advantage in being quicker in performing and more accurate in sizing the lens capsule opening, a step that allows access to the lens. In very white cataracts this may reduce complication rate.

I actually presented a continuing medical education talk to my fellow doctors showcasing some of the cases of femtolaser cataract surgeries I performed before to my fellow doctors 2 years ago at Gleneagles Hospital.

A Singapore study found that the laser cataract surgeries improved refractive outcome by less than 0.25 diopter, that is 25 degrees of power. Which is hardly necessary to change glasses prescription for.

At last Saturday’s Business Times health seminar, i also spoke about my current perception of the role of femtolaser cataract surgery. I could not agree more with surgeons who stand up for financial prudence on behalf of their patients. The same resources channeled into femtocataract can be channeled into better lenses, better measuring devices to improve lens power calculation and smaller wound sizes (I strongly advocate reducing it as much as possible and routinely offer 1.8mm incision for suitable cases). I firmly believe the latter 3 elements in combination play a much bigger role in improving the refractive results of routine cataract surgeries.

In general I see advantage in femtocataract only in select cases such as dense cataracts, white cataracts and shaky cataracts. Having said that, I also know for a fact that some of the top cataract surgeons in the world had tossed out their femtocataract lasers even for the most complex cases.

Final case in point: my last “conventional” phacoemulsification patient saw 6/6 in both eyes ( it was a bilateral case) at day 1 after op and you would not be able to tell she had her eye operation the day before. In comparison, my last femtolaser cataract surgery patient also saw 6/6 at day 1 after op, but her eye was very slightly pinker due to the suction imparted by the laser interface, and her insurance company was poorer by about 20% of the total bill.

So do try to sieve through some of the hype and marketing ploy which unfortunately is pervasive even in medicine, and I wish your mother a successful cataract surgery! Cheerio!

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