Is laser surgery for cateracts the future?

Is laser surgery for cateracts the future?

Sue Dickinson was accustomed to driving in the dark. Having worked as a cab driver, she was happy to chauffer her teenage grandsons Jack and George all over the country to play academy football, and was often on the road at night. But about three years ago, she realised something was wrong.

“I noticed my night vision wasn’t brilliant,” says the 67-year-old from West London. “I’d found out from a regular check-up when I was 60 that I had cataracts coming on, but it hadn’t bothered me at first.” She realised now, however, that she had to take action. Rather than opt for traditional cataracts surgery on the NHS, she decided to use her private medical insurance to help pay for femtosecond laser treatment. Under this procedure, which costs upwards of £2,500 per eye, an ultra-fast “femtosecond” laser breaks up the cataracts. It is widely held by private clinics to be the safer and superior option.

Sue paid extra to have her short-sightedness corrected during the same procedure so she would no longer need glasses. Both her eyes were done over three weeks, with each procedure taking just 20 minutes.

She is one of hundreds of Britons diagnosed with cataracts every day, all of whom have two options: free treatment on the NHS or this latest form of laser treatment chosen by Sue, which has hitherto only been available privately. But the country’s biggest eye hospital is now making laser surgery for cataracts available on the NHS for the first time. A trial involving 800 cataract patients at Moorfields Eye Hospital in London will compare laser with standard surgery, looking at visual outcomes, quality of life and complication rates.

Mark Wilkins, the consultant ophthalmologist leading the trial, is confident the laser method will come out on top, laying the foundations for it to become routinely available on the NHS. “Laser surgery for cataracts is the future,” he says. “But there is a lot of hype and money surrounding this technology and so far the potential benefits are unproven.”

A cataract is a cloudy patch in the eye’s natural lens. It is painless but can cause blurred or misty vision and make it difficult to see in dim or bright light. More than half of us will get cataracts at some point as we age, and the standard procedure to remove them is the most commonly performed operation by the NHS. Called manual phacoemulsification, it is done under local anaesthetic. Using a fine blade, the surgeon makes a tiny cut in the cornea at the front of the eye and then makes a circular opening in the front of the capsule that holds the affected lens. An ultrasound probe is then used to break up the lens, enabling it to be suctioned out with a special instrument. A new artificial lens made from clear plastic is inserted in its place. The procedure takes around 15 minutes and vision usually improves immediately. Most complications, such as swelling and redness, are minor and temporary. However two in 100 people who have standard cataract surgery suffer serious complications such as a tear in the capsule holding the cataract. This can lead to chronic inflammation, retinal detachment (in which the retina lining the back of the eye pulls away from its blood vessels) and poor visual outcomes, says Mr Wilkins.

The femtosecond laser, also done under local anaesthetic, automates many of the steps in this procedure and has the potential to reduce the complication rate. The laser machine first makes a detailed 3D image of the eye that shows up on a computer screen, enabling the surgeon to select precisely where the laser should be used. The surgeon depresses a foot pedal and the machine emits a femtosecond laser beam – so-called because each pulse lasts only one millionth of one billionth of a second – to make the initial cut in the cornea, cut the opening in the capsule and break up the cataract, all of which takes about a minute. An artificial lens is fitted in the same way as in the traditional method.

Sue is unequivocal about the benefits. “It was worth every penny,” she says. “My vision is brilliant now, much better than when I wore glasses even. I still can’t believe that I can stand in the rain watching a floodlit pitch at night and see perfectly.”

By Ruth Wood,

The Telegraph Monday 08 June 2015

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