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A cataract is a cloudiness that develops in the normally clear lens inside the eye. It occurs as a part of the eye’s ageing process – it is not a growth, a white film, or a kind of cancer, nor is it caused by overuse of the eye.

An age-related cataract is not something that was absent one day and just appeared the next day — it is actually the last phase of a series of gradual changes in the eye, starting in youth that eventually have an impact on vision in later life.

This is akin to other age-related changes in the human body, such as hair turning grey, and skin becoming wrinkled.

In modern societies, cataracts rarely cause blindness, but they do reduce the sharpness and quality of people’s vision, thus affecting their ability to do everyday work and leisure activities. When this occurs, surgery may provide the best solution.

Cataract Surgery Options and Benefits

There are numerous benefits from having the surgery — it is not uncommon for patients to feel that their vision following this surgery is better than it has been since they were 40 years of age.

And now, thanks to remarkable advances in intra-ocular lens design, many people can have the added convenience of being able to greatly reduce or avoid the need to wear reading glasses or distance glasses (though sunglasses are still advisable).

Who is Eligible for Cataract Surgery?

People who have a cataract that may require surgery will generally notice one or more of the following symptoms:

• Hazy, cloudy, or filmy vision, for example, when watching TV, reading, driving, etc.
• Decreased quality of vision at night, particularly with oncoming headlights.
• Increased sensitivity to glare or bright sunlight.
• Colours don’t seem normal or as bright as before (colours appear washed out).
• Double vision, even with one eye closed.

Cataracts generally start to become bothersome after age 60, although some people may not have problems until much later in life. Because cataracts develop gradually, sometimes people do not realise their vision is being affected until it has become quite blurred, and they have difficulty carrying out their everyday tasks.

Furthermore, age is not a barrier to to having cataract surgery – people over the age of 100 years have had the surgery! In fact, there is evidence that, in older people, an added benefit of the surgery is that it can reduce the likelihood of falls, hip fractures, and the need for admission to a nursing home.

If you are over 60 years of age and you have these symptoms, and you find that glasses do not correct the problem, then an eye examination is advisable in order to determine if a cataract has developed and if surgery is appropriate.

Astigmatism can be found either alone, or in conjunction with myopia or hyperopia.  Laser eye surgery can treat astigmatism alone, or when found in conjunction with myopia or hyperopia.

Do I Have Astigmatism?

Astigmatism is the most common vision problem. It is usually caused by an irregularly shaped front surface of the eye (the cornea). Astigmatism is accompanied by an inability of the eye to focus clearly. Astigmatism can occur alone or along with short sighted or long-sightedness.

Astigmatism occurs when the cornea is shaped more like a rugby ball and is more curved in one direction than the other, instead of shaped like a spherical soccer ball. The curves of a cornea with astigmatism skew the light and cause the inability of the eye to focus properly.

Almost all eyes have a little astigmatism, but in most cases, it is so minor that vision is not affected. For those have more than slight astigmatism, it can noticeably blur vision unless glasses are worn.

Astigmatism Correction

Today there are various forms of Astigmatism Correction. Depending on the patient, different treatments can be utilised.

Eye Glasses

Eye glasses can be used to correct regular astigmatisms. You need to be sure to have the correct lens and have them correctly lined up. Once you have accomplished this, you will be able to see extremely well.

Contact Lenses

Eye glasses or contact lenses can satisfactorily compensate for astigmatism. Against common perception, people with astigmatism CAN wear contact lenses. The following are two lenses acceptable for people with astigmatism:

1. Soft Toric Lenses can correct an astigmatism of the eye. Toric lenses are a flexible lense and have a prescription to correct the astigmatism. They can also have your a prescription if you are short or long sighted. If your eye does not fit the normal bell curve, they can be custom made for you.
2. Gas Permeable Lenses can correct even extreme cases of astigmatism. Because these are a semi hard lense, you will feel these lenses more than others. Over time, they will become more comfortable and provide great vision results. GP lenses will last much longer than toric lenses, though they are more of an investment monetarily.

Refractive Surgery

If you do not wish to wear eye glasses or contact lenses, you may wish to have refractive surgery. Most astigmatisms can be corrected with LASIK surgery. LASIK refractive surgery is a safe vision correction surgery that can fix your blurred eye sight and fix your astigmatism.

A virtually painless surgery, LASIK is an outpatient procedure that can be carried out in Vision Eye Institute Clinics. Recovery time is minimal and you can be back to your regular routine within days!

An astigmatic keratotomy may also need to be performed if the patient does not feel completely satisfied after their LASIK surgery. It reduces the degree of the astigmatism changing the shape of the cornea from round to an oval shape. This can improve eye sight to the patient and is most frequently carried out on patients that have previously suffered from cataracts.

Did you know that approximately 50% of Australians wear glasses or contact lenses to see clearly and most people will need them at some time during their life for reading?
Laser eye surgery is a lifestyle choice for people who want to reduce their dependence on glasses or contact lenses for many different reasons:

• Glasses are uncomfortable or annoying
• Can’t tolerate contact lenses
• Swimming, surfing, diving
• Playing sports – cricket, golf
• Wedding day
• Lifestyle/fashion

If you want to experience the freedom of clear vision without glasses or contact lenses, laser eye surgery may be the answer for you.

Vision Laser at Vision Eye Institute combines Australia’s most experienced laser eye surgeons with the latest technology and surgical techniques to give you clear vision and a new way of life. Many people, once they have had laser eye surgery, tell us “I should have done this years’ ago.”

In the past, if you suffered from shortsightedness, long-sightedness or astigmatism, you had no option but to wear glasses or contact lenses to see clearly. But many people find these uncomfortable and inconvenient for many daily activities. You may dislike how you look in your glasses or the fact that you have the ongoing replacement costs.

Millions of procedures have now been safely performed and the excellent safety profile and accurate results of modern laser techniques means you can confidently choose to live your life free from the constraints of glasses and contact lenses.

Advanced Surface Laser procedures are sometimes described by the terms ASLA, ASL, PRK, LASEK, Nu-LASIK or Epi-LASIK. This procedure involves lasering the surface of the cornea rather than creating a flap first, as is performed with LASIK.

At Vision Laser, this type of procedure is usually recommended if you have thin, irregular or an unstable cornea which means you are not suitable for LASIK. The end visual result is the same as with LASIK, providing you with excellent vision without the need for glasses or contact lenses.

The main difference between having Advanced Surface Laser and LASIK is the recovery from surgery, which is usually longer and more uncomfortable than with LASIK.

Advanced Surface Laser eye surgery can be used to correct short-sightedness and astigmatism and can sometimes be used for small degrees of long-sightedness.

Advanced Surface Laser Procedure

The Advanced Surface Laser procedure takes about 15 minutes per eye:

• The cornea is anaesthetised.
• Anaesthetic drops are applied to the eye, and an eyelid holder is put in place to keep the eye from blinking. Additionally, anti-inflammation eye drops are applied to the cornea in order to reduce the post-surgical reaction and discomfort.
• The corneal epithelium layer is removed.
• The front surface layer of the cornea (epithelium) is gently lifted away from the rest of the cornea. This exposes the corneal ‘bed’, which is now ready to receive the energy from the laser beam.
• The cornea is re-shaped by the laser.
• The laser beam, consisting of UV energy, vaporises a pre-determined amount of tissue from the corneal bed, thus giving the cornea the new shape required to correct the eye’s optical prescription. Then, the loose epithelium tissue can be placed back over the corneal bed.
• A soft contact lens is applied.
• The eye is fitted with a “band-aid” soft contact lens for added protection while the surface of the eye heals. Antibiotic eye drops are also applied.
• Anti-inflammation eye drops are prescribed.
• About 4 days after surgery, the contact lens is removed, and a course of mild anti-inflammation eye drops is commenced.
• The ASLA technique is similar to the PRK and LASEK techniques, but with some refinements to aid the recovery of the eye.
• It is possible to have both eyes treated on the same day.

Post-Op Visual Recovery

It can take 4 days or more for you to achieve useful vision.

Post-Op Comfort

The eyes usually feel gritty and sore for about 2 days after surgery and, in some cases, they may even feel painful initially after the eye surgery.

Post-Op Stabilisation of Prescription

Stabilisation takes about 1-2 months.

Post-Op Corneal Haze

A mild haze may be present but this usually settles down after a few weeks.

Known Risks/complications: At this time there are fewer complications when in comparison with standard Lasik as the flap that is created is much more precise and cleaner. The vast majority of complications with Lasik tend to be flap related.

Dry Eyes: There is actually much less of a chance of acquiring dry eyes if you have Intralase.

Recovery Time: Recovery time is definitely faster than compared with standard Lasik and vision stabilises quicker as well.

Results: Getting Intralase provides an individual a greater opportunity of achieving 20:20 vision following surgery. It not only improves the quantity of your vision (how far you can see down the test chart) but it also improves the quality of your vision, meaning you are less likely to have night vision complications following surgery.

The previously mentioned information and facts is intended for educational purpose exclusively, please contact vision eye institute in the event that you have any kind of concerns concerning your own vision. Information and facts offered were not necessarily constructed by Dr Gerard Sutton and is created simply to distribute knowledge concerning Intrase LASIK.

It uses a femtosecond laser, of the same type used to create the flap in LASIK to make lens and cataract surgery safer, more accurate and more predictable. Cataract surgery is the commonest eye operation in the world. Over 200,000 procedures are performed in Australia per year, about 3.4 million in the United States and about 18 million worldwide. Increasingly lens removal and replacement with an intraocular lens is seen as a way of vision correction for those people who have refractive errors and a desire to be free of glasses.

As a rule, anyone below the age of fifty would like to retain their own crystalline lens because it retains some elasticity to help with the range of focus. It is a gradual process which begins in the early forties, but after fifty the lens has lost much of its elastic property and this is why normal people need reading glasses at age forty five plus. If you are aged fifty five plus and want to be free of glasses, then one way of achieving this is to remove the now non-elastic lens and replace it with an intraocular lens.

These come in different types and are a discussion for another day. Back to the point of laser lens surgery; there are three critical elements that could be make better both in safety and accuracy terms;

1. The incision is currently done with a blade, sometimes metal, sometimes diamond, and to create the incision with a laser will add to the level of safety. The most feared complication of lens surgery is infection and it is believed that slight leakage of the wound in the first few days is one possible cause for infection. If the wound could be made more secure and more certain in its structure, which is what can be done with a laser, then it may decrease this feared risk of lens surgery. If you create the incision in a precise manner, it also means that you have less induced astigmatism and a better quality visual result.

2. The capsulotomy, that is the removal of the front part of the lens, is currently done with a needle and forceps directed by the surgeon’s hand. You have to make approximately a 5mm opening in the front of the human lens in order to then be able to extract the body of the lens. Around 1% of the time, this capsular rhexus tears and this can lead to problems of lens stability. Sometimes it is not possible to remove the entire lens and sometimes-other problems arise following this such as not being able to place the desired lens or not being able to fix it safely in place. So the series of problems cascade, like many issues in surgery, if the capsulotomy is not done perfectly. This has already been shown in at least one published series to be better when performed with a femtosecond laser. That addresses the safety side of the capsulotomy. On the accuracy side, if you have a round properly centred capsulotomy, it means that the synthetic lens you place in the eye will be more accurately positioned and lead to a better visual outcome. Again this has been shown in a paper by Zoltan Nagy to be achievable. If, for example, you want to have a consistent size within 0.25mm you can achieve this every time with a femtosecond laser and you achieve it about 10% of the time with a skilled surgeon.

3. The third aspect of surgery that can be improved is the softening of the lens. Currently this is done with an ultrasound and is called phacoemulsification. This began in the 1970’s and continues to this day as the preferred method of softening the lens so that it can be aspirated through a fine cannula, the reason being that you want to keep the wound small. If you enlarge the wound it adds to the risk and decreases the accuracy, but to keep the wound small you need to be able to soften the crystalline lens or cataract and remove it. The femtosecond laser allows either reduction in the amount or sometimes elimination of the need for phacoemulsification. Phacoemulsification is a controlled process but it does have potential and real risks inside the eye that can lead to problems with lens placement and corneal endothelial damage. A reduction or elimination of phacoemulsification will also lead to better wound integrity.

On all three aspects incision, capsulotomy and lens removal, laser lens surgery appears to be superior in safety and accuracy. My best estimate is that this will be available in Australia in 2011 and I would dearly love to have the first instrument in Australia. There will be a number of competing technologies but at this stage the Alcon LensX certainly has the edge in both USA Government approvals and the best of the research and development teams behind it, along with the service and high quality reliability of a company like Alcon. It has gained approvals for all the essential elements; that is the incision, capsulotomy and lens softening as regulated by the USA FDA. Laser lens SMA will be utilised by surgeons who are currently performing refractive lens surgery on the population who wish to be free of glasses, and for whom LASIK is not appropriate will probably use it. These are the people who are relatively risk averse and would like a safer more certain procedure in order to proceed with surgery, and in my estimation, over a few years it will become the standard of care for cataract and lens surgery generally. It has many implications for patients, the profession of ophthalmology and government regulators.

These machines are expensive to purchase and service and it is not a bad thing that the surgery will be concentrated in certain facilities. A small facility doing less, for example, than 1,000 procedures per year, will probably not be able to afford this technology. The concentration that will result does allow for a build up of expertise in nursing staff and the team that is involved these days in modern lens surgery. This will be the technology at the right time because demographics drive many things, and 65 year olds who are the first of the baby boomers who turn 65 in 2011, and after them a demographic bulge of population in all western countries, will be at an age where lens surgery is appropriate for them, and it is just as well that a safer, more accurate technology has come along at the right time. Laser lens surgery is truly the right technology for the right time. It uses a femtosecond laser, of the same type used to create the flap in LASIK to make lens and cataract surgery safer, more accurate and more predictable.

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