Bladeless Cataract Surgery in Singapore: What Actually Is “Bladeless”?
Bladeless cataract surgery is bound to come up quite a bit if you have been looking up and researching cataract treatment in Singapore. But what exactly is bladeless and what exactly are the benefits of bladeless cataract surgery versus conventional cataract surgery:
- Is it safer?
- More precise?
- What is the extra cost, and is it worth it?
In this guide, we delve into what bladeless cataract surgery in Singapore actually is, how it is different from conventional cataract surgery, and whether it benefits everyone.
Bladeless – Femtosecond Laser for Selected Steps
You may be inclined to think that bladeless cataract surgery excludes the use of surgical instruments totally, but it is not true. The procedure merely uses a femtosecond laser to perform certain key steps of a cataract surgery instead of conventional handheld surgical blades.
Bladeless cataract surgery, medically known as laser-assisted cataract surgery.
Conventional cataract surgery still remains the most used and most preferred surgical choice for most cataract surgeons today. During the procedure, the surgeon uses fine instruments to:
- Create small 2 to 3-mm incisions on the cornea
- Open the front of the lens capsule (capsulotomy)
- Break up the cloudy lens into smaller pieces
On the other hand, bladeless cataract surgery uses a femtosecond laser to perform some of these steps before the surgeon goes on with the rest of the procedure.
Plainly put, “Bladeless” means laser-assisted steps for selected parts of cataract surgery. It is not entirely true to say it is a completely blade-free procedure.
Step-by-Step: Conventional vs Laser-Assisted Cataract Surgery Workflow
To understand the differences between the 2 methods of cataract surgery, it helps to compare the workflows.
1. Corneal incisions
During a conventional cataract surgery, the surgeon uses a blade to create small 2 to 3mm incisions on the cornea, while during a laser-assisted cataract surgery, a femtosecond laser is used in lieu of creating the incisions with pre-determined depth, length and positio
2. Capsulotomy (Opening the lens capsule)
The surgeon creates a circular opening in the capsule manually using forceps in a conventional cataract surgery. It takes a skilful and experienced surgeon to ensure ideal symmetry and centration. On the other hand, the femtosecond laser does the same with a femtosecond laser in a laser-assisted cataract surgery. The diameter and position are computer-controlled.
3. Softening and fragmenting the lens
Conventional cataract surgery uses ultrasound energy known as phacoemulsification to break up the cataract inside the eye, while laser-assisted cataract surgery uses the femtosecond laser to pre-soften and fragment the lens before using ultrasound for removal.
4. Lens Removal
Both methods take out the fragmented cataract using ultrasound and suction.
5. Intraocular Lens (IOL) Implantation
Lastly, both methods implant a clear artificial intraocular lens (IOL) into the capsular bag to replace the cataract that is removed.
Why Does the Capsulotomy Step Matter?
A capsulotomy is a procedure that creates an opening in the lens capsule (the membrane surrounding the lens) during cataract surgery. It may not sound like a key step, but it has a direct impact on lens positioning, stability and visual outcomes.
This step matters especially when inserting multifocal IOLs like trifocal and extended depth-of-focus (EDOF) lenses, and toric lenses to correct astigmatism.
These lenses, which offer more convenience than a monofocal lens is more sensitive when it comes to positioning. Even minute decentrations can affect the visual outcome. A well-centred and consistently sized capsulotomy will optimise lens alignment.
Who May Benefit Most From Bladeless Cataract Surgery
It is sometimes purported that those with astigmatism, those opting for multifocal and toric lenses or those with shallow anterior chamber, dense cataract or small pupils would benefit more from laser-assisted cataract surgery, as it requires more skills, experience and precision to achieve a good visual outcome.
The truth is, in the hands of an experienced and skilful cataract surgeon, most people do not require laser-assisted cataract surgery as it can significantly increase the cost of surgery while not achieving a great difference in surgical outcomes.
Limitations & Realistic Expectations of Bladeless Cataract Surgery
While there is much excitement surrounding bladeless cataract surgery, we must note and understand what is not:
It is not risk-free, and like conventional cataract surgery, it carries the same potential risks including infection, inflammation, retinal detachment and posterior capsule rupture.
It Is Not Always Necessary
For the vast majority of the population, conventional cataract surgery already delivers good results. An experienced surgeon performing conventional cataract treatment in Singapore can achieve good outcomes without the need of a femtosecond laser.
While the aim of the laser technology is to improve precision, it does not guarantee better vision in every case.
It Does Not Replace Surgical Skill
The surgical outcome ultimately lies in the surgeon’s expertise and experience and remains the most important factor. It should be noted that the femtosecond laser only performs certain steps during a cataract surgery, the cataract surgeon is still the one who oversees the entire surgical procedure, removes the cataractous lens, implants and positions the IOL in the eye and manages all possible complication at the surgery table.
Safety & Outcomes: What Studies Generally Show
Research and clinical data have shown that both conventional and laser-assisted cataract surgery result in similar level of safety, complication rates and most importantly, the long term visual outcomes largely are similar.
When considering bladeless cataract surgery in Singapore, ask your surgeon:
- Am I likely to benefit medically from the procedure?
- What is the severity of my cataract and does it warrant a laser-assisted procedure?
- What is your experience with both methods?
- What are the specific benefits vs risks in my case?
The decision to choose between a conventional and laser-assisted cataract surgery should be a personalised and customised one, and not driven by marketing and advertising.
Cost Considerations in Singapore
One of the biggest differences between the 2 methods is cost. In Singapore, cataract treatment fees vary and are dependent on:
- surgeon’s seniority, experience and expertise
- type of IOL used: multifocal and toric lenses are more costly
- location of surgery: private versus government, surgery centre vs hospital setting
- technology: conventional or laser-assisted surgery, with the latter costing more
People should be prudent in choosing the most suitable method of treatment – one that is customised and tailored to an individual’s specific eye condition, lifestyle and professional needs. The latest technology does not always necessarily mean it is the best or required surgical option.
Consultation Checklist: Am I a Good Candidate for Laser-Assisted/Bladeless Cataract Surgery?
Ask the cataract surgeon the following questions during your consultation:
- Can I benefit medically from laser-assisted cataract surgery?
- What are the advantages specifically in my case?
- What is the difference in cost?
- What outcomes can I realistically expect?
- What is your success and complication rate?
Final Thoughts
To summarise, bladeless cataract surgery uses a femtosecond laser, aiming to improve accuracy in selected steps of cataract surgery. However, it cannot be assumed that it is able to offer a better visual outcome for every eye.
For cataract treatment in Singapore, both conventional and laser-assisted cataract surgery are widely performed and considered to be equally safe and effective. The final choice will depend on eye condition, lifestyle needs, budget and surgeon’s recommendation.
If you are considering bladeless cataract surgery in Singapore, it would be more beneficial to evaluate whether the technology can meaningfully improve the surgical outcome. More often than that, a good surgical outcome is not just dependent on advanced tools, but on making informed decisions and choosing the right surgeon.
