Enhancing Precision in Caract Surgery
Hartford Hospital’s Eye Surgery Center was the first facility in the state with new laser technology that makes cataract surgery more precise and predictable than ever.
If you don’t have a cataract, chances are you know someone who does. Cataracts — a clouding of the eye’s lens that results in decreased vision — are fairly common, with most people developing them with age.Fortunately, surgery to remove the cataract can usually return vision to normal. At Hartford Hospital’s Eye Surgery Center in Newington, Conn., ophthalmologists are now using innovative laser technology on select patients to perform the most exacting steps in cataract surgery with unprecedented precision — and without using a scalpel. The center acquired the Alcon LenSx® Laser system in December 2012. Center administrator Dwayne Kertanis says that ophthalmologists at the center performed 1,700 laser-assisted cataract surgeries in the first nine months of use. Mr. Kertanis notes that, according to the laser’s manufacturer, the center was the first in New England to use the laser and that it also performs the largest volume of laser-assisted cataract surgeries in the Northeast.
Leading-Edge Technology
The laser’s sophisticated capabilities allow surgeons to use three-dimensional imaging to customize surgery to each patient’s unique eye measurements and contours. Surgeons then preprogram the laser to perform key steps in the surgical process. Lasers are used in many areas of medicine, and have been used in ophthalmology for LASIK surgery and other procedures.
“This is really the first time it’s being applied to cataract surgery,” says Raji Mulukutla, MD, an ophthalmologist in Hartford Hospital’s ophthalmology department.
Dr. Mulukutla notes that cataract surgery is the most frequently performed surgical procedure in the United States today. It involves opening the lens capsule, removing the patient’s own lens and the cataract material, and inserting a fabricated intraocular lens. The laser, Dr. Mulukutla says, “turns cataract surgery into a bladeless operation and gives us a great deal of precision in making the opening in the capsule and removing the contents.”
Martin Seremet, MD, of the hospital’s ophthalmology department, also operates at the center. He says the laser can be particularly helpful in correcting some mild to moderate cases of astigmatism during cataract surgery. Astigmatism occurs when the cornea — the outer portion of the eye — develops an irregular shape that causes blurred vision.
Surgeons can make small incisions in the cornea by hand to correct the astigmatism. “But those incisions are not as reproducible. They depend on the surgeon’s skill and control,” says Dr. Seremet. “The laser can provide extremely reproducible incisions.”
Steps in Surgery
In conventional cataract surgery, the surgeon first uses a hand-held scalpel to make an incision in the cornea and gain access to the cataract. In laser-assisted surgery, the laser, preprogrammed for the patient’s unique eye configuration, makes the incisions with superior precision.
Day Of Your Appointment
The next step is to create a circular opening in the capsule, which is a membrane covering the lens. This is one of the most crucial steps in the process because it affects the ultimate positioning of the lens implant. In the standard approach, the surgeon uses a hand-held instrument to make the circular opening. In laser-assisted surgery, the laser is used to create the opening, based on the exact presurgical measurements.
“We think that being able to make that opening so perfectly round and centered using the laser will greatly improve placement of the intraocular lens,” Dr. Mulukutla says. “This becomes particularly important when we’re using advanced-technology intraocular lenses that are either multifocal or designed to correct astigmatism.”
Once the opening is made, the surgeon removes the cataract material. This is done using a machine that employs ultrasonic energy to break up and remove the cataract. Here, too, the laser is helpful. It divides the cataract into multiple, small segments, so it can be removed with approximately 43 percent less ultrasonic energy. This is beneficial, Dr. Mulukutla points out, because “the more energy you use, the more damage you can potentially do to the inner aspects of the eye, particularly the cornea.” Less ultrasonic energy, she says, “is less traumatic, so healing is quicker, with a smoother postoperative course.”
The entire procedure takes from seven to 20 minutes, depending on the individual cataract and eye, with the laser operating for about 30 seconds. Dr. Mulukutla says patients tell her the experience is amazing — very high-tech, with a lot of lights seen from the patient’s perspective. Plus, she says, “Patients love the fact that I am not using an actual scalpel.” The center’s outcomes from laser-assisted surgery have been excellent, she says. “We have great results and no complications with the use of the laser.”
Skill and Experience
Ophthalmologists who practice at the center have had extensive classroom and hands-on training in use of the laser, and each performed multiple cases under expert supervision before operating independently. Dr. Mulukutla estimates that she alone has performed more than 200 laser-assisted surgeries since January 2013.
Hartford Hospital’s Eye Surgery Center, founded in 1998, performs more than 8,400 surgeries a year, the vast majority of them cataracts. The addition of the advanced laser further distinguishes the center. “The fact that Hartford Hospital invested in this technology puts us at the forefront, with cutting-edge technology many cataract surgeons don’t have access to,” Dr. Mulukutla says. She points out that more than 40 ophthalmologists from multiple private practices throughout central Connecticut choose to perform their surgeries at Hartford Hospital’s Eye Surgery Center.
“We all use this facility for surgery because we all believe it is the best possible place we can take our patients,” she says.