Bladeless laser cataract surgery

by | March 26, 2015

This latest treatment allows patients to heal faster and less of the usual side effects.


BY: Phua Li Hwa

Cataract is a natural phenomenon of ageing and many will have to undergo the cataract removing surgery by the time they reach their 70s. In Singapore, 95 percent of those aged 70 years and above have had cataract surgery. Without surgery, cataract can lead to blindness.

Cataract is the clouding of the natural lens in the eyes, as a result of the oxidation process caused by UV exposure. It causes impaired vision because the cloudy lens block transmission of light to the retina. Common symptoms include blurry vision, glare or occasional double vision. To remove the cataract, the option is to have surgery and replace the eye with new artificial lens. However, now there is an advanced treatment for cataract surgery called the bladeless cataract laser surgery.

Ageless Online talks to ophthalmologist Dr Chua Wei Han, medical director at Parkway Eye Centre in Mount Elizabeth Hospital, about the new surgery:


To start off, what does a typical cataract surgery involve?

The process of a cataract surgery involves removing the cataract and replacing the human’s natural lens with an artificial lens. The surgeon firstly creates an incision at the side of the eye and opens the capsular bag, a sack-like structure containing the natural lens of the eye. Next, the surgeon breaks up the cataract into pieces and removes the cataract pieces out of the capsular bag. Lastly, the surgeon replaces the human’s natural lens with an artificial lens.


How is the bladeless laser surgery different from the traditional cataract surgeries?

For the past two decades, most eye surgeons have used the traditional technique called phacoemulsification, which involves the use of surgical blades and ultrasound in the wound creation and cataract fragmentation process. As such, the success of the surgery depended highly on the skills of the doctors, and the surrounding eye structures may be damaged by the use of excessive ultrasound.

Now, the bladeless laser cataract surgery is the advanced technique that does not involve the use of surgical blades on the eye, and uses laser instead to reduce risks. With laser technology involved in every step of the surgery, surgeons are able to conduct a more predictable surgery with better safety and precision. The surgeon can plan from the exact location and the size the wound is created, to the size of the cataract fragmentation. The laser technology used has been proven in Lasik surgery and is now been adopted for the bladeless cataract surgery. As the surgery does not involve the use of surgical blades on the eye, there is no stitching or bleeding involved.


What artificial lens choices are available?

Monofocal lens – This is a high quality lens that delivers excellent vision at only one distance. One of the common techniques is to correct both the patient’s eyes to see far, but ultimately, the patient would still need to wear reading glasses.

Monovision lens – This technique is where one eye is corrected to see far while the other eye is corrected to see near, and both eyes will adjust over time to see one distance. For this, a small percentage of patients may have initial problems balancing their visions and it would take some time for the eyes to get used to it. It is advisable for patients considering the monovision technique to try on the contact lens provided by the clinic as a test bed for a period of time, before deciding if it is suitable for them.

If the patient’s occupation requires the sharpest possible distance vision at all times or excellent night vision, for example being a pilot or night driver, or if they have a pre-existing eye condition such as macular degeneration, they are probably more suited for monofocal lens.

Multifocal lens – This lens allows the patient to see near, intermediate and far. This is a more convenient alternative for patients, as they do not need to rely on reading glasses. This lens is made up of concentric rings of varying optical power, and each brings light into focus at different points in the eye simultaneously. In that way, both distance and near objections are in focus. One possible side effect is patients may see halos or glares. For some patients, it usually takes three to six months for the halos to subside, while others just get used to it. Another potential side effect is that patients may experience decreased contrast sensitivity under dim light. As such, multifocal lens may not be suitable for people who need to see in dim light often. Multifocal lenses are more suited for patients who have healthy eye condition, do not require extremely sharp distance vision and do not want to depend on glasses anymore.

Toric lens – This lens is designed to treat astigmatism. If the patient has high astigmatism, he could opt for the astigmatism-correcting monofocal or astigmatism-correcting multifocal lens implantation.

In a nutshell, every patient has his own eye health or pre-existing eye condition. It is best to consult the doctor on the patient’s eye health before discussing the suitable options to match the individual’s needs.


It is said that the patient is able to have this surgical procedure customised to them, based on the anatomy of his eyes. Can you explain further?

If the cut on the eye and the opening of the capsular bag is not regular in shape, the artificial lens would not be positioned accurately on the centre of the eye, and the vision would not be sharp. But now with the high precision of laser, the opening of the wound on the eye can now be customised according to the anatomy of the eye.


How quickly will the wound on the eye heal?

It takes about three weeks for the wound to heal, whereas the vision will be restored quickly a day after the surgery.


How does the new procedure promote faster wound healing to the eye?

The architecture and construction of the wound on the eye is very precise, as compared to a wound that is done manually. Hence, the wound will tend to heal better and faster.


How long does the surgery take?

The surgery takes 15 minutes. It is a day surgery with no need for hospitalisation.


Are there any side effects to this new procedure?

As the eye will be pressed slightly by the laser during the surgery, the only side effect is the patient may get red eye right after the surgery, but the redness typically disappears within a few days.


What are the to dos or not to dos after the surgery?

Do not rub eyes during the three weeks’ recovery period. Avoid swimming or playing contact sports as it may stress the wound on the eye to open up.


How much is the surgery and can Medisave be used to pay for it?

The bladeless laser surgery with its lens implantation costs from S$7K onwards, depending on the various lens suited for the patient. This does not include consultation, hospital facility, any medication or GST charges yet. You can use up to S$2,450 from your Medisave account.


SIDEBOX: A perspective from a bladeless laser cataract surgery patient

Mohammed Najib bin Ariffin, 53, had unknowingly suffered from cataracts for a year before he realised his condition. It was only after hearing about cataract symptoms from a close friend that he found that that maybe the reason he was having cloudy vision. Ageless Online asks him about the new procedure:

How were you affected by cataract before the surgery?
My vision was gradually growing cloudy and blurry over the years. It got to a point I refrained myself from driving at night as it had become too dangerous for me.

What made you try this new procedure? Did you do any research before you made the decision?
I was initially looking for a procedure that could treat my cataracts. After knowing that this surgery could also correct my shortsightedness at the same time, I got even more interested. Furthermore, my wife has also heard about this procedure in the newspaper and TV, and that gave me the assurance that this was indeed a legitimate, proven and safe surgery.

How do you feel now after the surgery?
When I wake up in the morning, my vision is sharp and I feel so refreshed throughout the day. Even when I face the broad daylight, I do not have issue of getting glare in my eyes. Now, I can view things normally under dim or bright lights. I have heard rumours that patients of traditional cataract surgery suffer side effects of headaches when carrying heavy weight and painful glare under sunlight. However, I did not experience any of these after the bladeless cataract surgery.

How were you told to prepare before the surgery?
I was told not to consume food or drinks two hours pre-surgery. In order to prevent any bacteria infecting my wounds after the surgery, I was advised to avoid any contact sports or water sports. During bedtime, I had to wear the eye masks to prevent any unconscious scratching to my eyes. With regards to the post surgery follow-up sessions, I had to return for check-ups one day, one week, one month and three months respectively after the surgery.

Would you recommend this surgery to others?
Definitely. I am already spreading this surgery via word-of-mouth to my friends.




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