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Rapid evolution – Editorial from Prof Bekir Sitki Aslan

Cataract surgery has moved from high risk to safety

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Bekir Aslan

Posted: Tuesday, October 2, 2018

During the last few years, IOLs have come to allow the correction of presbyopia, astigmatism and spherical and chromatic aberrations, prevent posterior capsule opacification, block wavelengths that are potentially dangerous for the macula and also maintain accommodation. We have been witnessing an ever-increasing dissemination of all advanced technology lenses in general, but especially toric lenses.

Advancements in IOL technology improve visual functionality by creating customised IOLs or modifying optical power postoperatively.

Physicians now have access to advanced diagnostics that can better quantify conditions such as dry eye, light scatter and posterior corneal astigmatism, to enhance refractive measurements and help with selecting the appropriate IOL.

The innovative Zepto and the Capsulaser devices provide pristine capsulotomies though they work differently.

The active fluidics of the CENTURION Vision System yield reduced CDE output compared to gravity-based systems, which, in turn, creates a safer, more stable surgery and quicker visual recovery.

The ultrasound phacoemulsification represents the gold standard for cataract extraction, but a new femtolaser energy source seems to be about to prevail. However, we do not know if the new generation of femtosecond lasers for cataract surgery is one of the most important innovations of the beginning of the century; but we are sure it is the most exciting for the future.

The MiLoop is to dissect the cataract into multiple pieces, while it is still in the capsular bag to reduce ultrasonic energy

A well-dilated pupil is critical for good outcomes, and Omidria (an injection of phenylephrine and ketorolac) might fit in the practices. However, pupil expansion devices may be needed in up to 10% of cases.

Alcon will launch the first image-guided aberrometer called ORA with VerifEye Lynk, as well as the next-generation Verion. With Verion, image-guided surgery will be streamlined to connect pre-op diagnostics, case planning and surgical guidance.

In summary, in a relatively short time, cataract surgery was transformed from a procedure with significant morbidities and high risk of vision loss to one of the safest and functional procedures in modern medicine.

* Bekir Sitki Aslan is Head Of Eye Department, Ankara Memorial Hospital, Turkey