What are the different ways to remove Cataracts? From Couching to Laser.

Cataract surgery is one of the most popular procedures performed worldwide. The first cataract procedure was performed in the 5th century BC^[1] and since then, over 9.5 million cataract surgeries are performed each year, across the world.^[2] The methods of cataract surgery have improved dramatically since the 5th century BC and is now considered one of the safest and most effective surgical procedures.

This post will explore the history of cataract surgery and the advancements in the technique and technology over time.

The 5 main ways that have been used to remove a cataract are:

1.     Couching

Couching is the earliest known method of removing a cataract. This method doesn’t actually remove the cataract lens from the eye; the lens is merely dislodged out of the visual axis and into the vitreous cavity (back jelly part of the eye) using a needle. Although this procedure does provide an initial improvement in vision, the inflammation and trauma induced to the eye often causes blindness shortly after. Despite its deleterious effects, couching is still unfortunately used in some developing countries.

2.     Extracapsular cataract extraction (ECCE)

Extracapsular cataract extraction involves making a large incision on the side of the cornea which the surgeon will use to access the eye. Another incision is made on the front of the lens capsule and the lens is removed in one piece with the back of the lens capsule left intact. An artificial IOL is then implanted to replace the cataract lens. Sutures are required to close the corneal incision.

As ECCE requires less advanced technology compared to more modern methods of cataract surgery like phacoemulsification (see below) it is the most commonly performed cataract surgery in developing countries where cost may be a prohibitive factor.^[3]

3.     Intracapsular cataract extraction (ICCE)

Intracapsular cataract extraction involves making an even larger incision as compared to ECCE. Both the lens and surrounding lens capsule is then removed. Because such a large incision is needed and the entire lens capsule is removed, there is a relatively high risk of complications with ICCE that may lead to blindness. This procedure is rarely performed nowadays.

4.     Phacoemulsification

Phacoemulsification is the most common type of cataract surgery technique performed today in developed countries. It involves creating a small incision in the cornea using a scalpel by hand. A microsurgical instrument is then used to create a circular opening in the lens capsule. This opening gives access to a special probe which releases ultrasound waves to break up the cataract lens. Once the lens is broken up, it is sucked up by the same probe device. Finally, the artificial intraocular lens is implanted into the lens capsule to replace your cataract lens. The initial incision in the cornea is self-sealing and does not require stitches.

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5.     Laser-assisted cataract surgery

Laser-assisted cataract surgery is the newest advancement in the field of cataract surgery. It involves the use of lasers instead of manual tools to perform the procedure. Firstly, your surgeon will use a special imaging device to acquire information about your lens which is then sent to the computer-controlled Femtosecond laser. This information programs the laser to facilitate the cataract procedure. Next, an incision is made in the cornea and an opening is created in the lens capsule, all done using the Femtosecond laser. The laser can also be used to soften the lens so that it is easier to break up using the ultrasonic probe. Finally, just like phacoemulsification, the cataract lens is suctioned away and an artificial intraocular lens is implanted with no stitches required.

 

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Which procedure will I have?

George St Eye Centre offers the two modern cataract procedures – phacoemulsification and laser-assisted cataract surgery. Laser cataract surgery allows an ophthalmologist to achieve a higher level of accuracy than if he or she performed the procedure manually, leading to better outcomes for the patient. Regardless of the choice of procedure, the visual outcome and refractive results of both surgical options are the same and equally as successful in the hands a skilful surgeon.

How can George St Eye Centre help?

The team at George St Eye Centre are cataract specialists who have improved the vision of hundreds of Sydney residents using cataract eye surgery. If you would like more information, please call us on (02) 9230 0010. 

 

^[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139750/

^[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185079/

^[3] https://www.aao.org/eyenet/article/phaco-ecce

^[4] https://onlinelibrary.wiley.com/doi/10.1111/aos.13055#

^[5] https://onlinelibrary.wiley.com/doi/10.1111/aos.13055# (modified)