TL;DR/Summary:
- Both standard and laser-assisted cataract surgery are safe and effective
- A laser is only used in certain steps, not the full procedure
- Surgeon skill and IOL choice matter more than the surgical method
- Laser carries a higher cost; not everyone benefits medically
- Consult your surgeon to decide what suits your eye condition
With an ageing population in Singapore, as long as we live long enough, there will come a time when cataract surgery is needed, as cataract is largely an age-related eye disease. For those researching information about cataract surgery in Singapore, the option of laser-assisted cataract surgery versus standard cataract surgery definitely comes into play.
When it comes to receiving cataract treatment in Singapore, both surgical options have a high level of safety, efficacy, and effectiveness, and are widely performed.
The main difference between the two procedures lies in certain steps during a laser-assisted cataract; a femtosecond laser is used instead of traditional surgical instruments. The choice of which surgical method will depend on one’s eye condition.
Below is an easy-to-understand guide to help you understand what you really need to know when deciding on the surgical method to choose from – laser-assisted cataract surgery (bladeless cataract surgery) or standard cataract surgery.
Quick comparison table
| Surgical Step | Standard Cataract Surgery | Laser-Assisted Cataract Surgery (Bladeless) |
|---|---|---|
| Corneal incisions | A blade is used to manually create incisions | A computer-guided femtosecond laser is used to create incisions |
| Capsulotomy | The opening of lens capsule is created manually | Opening of lens capsule is created with a laser |
| Breaking the lens into small pieces (fragmentation) | Phacoemulsification – ultrasound is used to break up lens | A laser pre-softens lens before ultrasound is used to break up lens |
| Technology | Conventional technique | Bladeless cataract surgery or laser-assisted cataract surgery in Singapore |
In today’s context and with overhyped marketing and advertising, laser-assisted cataract surgery is perceived to have certain advantages, including improving the accuracy of the procedure for those with astigmatism and reducing the amount of ultrasound energy used during the procedure. It is also widely marketed as a ‘high-tech’ procedure for those seeking ‘premium’ options for cataract surgery.
However, it needs to be noted that both methods still utilise ultrasound to remove the cataract. The femtosecond laser is used only in certain steps of cataract surgery and not the entire procedure.
What really matters medically?
Overhyped marketing and advertising aside, does laser-assisted cataract surgery really provide a better surgical outcome? Let us delve more into this:
- Capsulotomy consistency: A circular opening can be made manually or with a laser in the capsule (thin membrane) that holds the natural lens. It is perceived that a laser is able to create a more consistent opening and thereby may improve the positioning of the intraocular lens (IOL) in terms of centration, especially for multifocal (bifocal or trifocal) or toric IOLs.
- Incision geometry: Corneal incisions created need to be self-sealing, structurally stable, and precisely located. Laser may offer a certain level of predictability that some cataract surgeons in Singapore may find value in complex cases.
- Correction of astigmatism: Some cataract surgeons may advise laser-assisted cataract surgery in view of the presence of astigmatism for a better visual outcome, as it is purported that accurate and image-guided cornea incisions with a laser can decrease the incidence of astigmatism.
It must be noted that the surgical outcome is not solely dependent on how the cataract is broken down and, removed, and on the lens position. A lot also hinges heavily on pre-surgery diagnosis, pre-operation measurements, selection of lens, and the experience and skills of the cataract surgeon during the procedure. Studies have shown that both standard cataract surgery and laser-assisted cataract surgery can provide equally good visual outcomes.
Higher fees are associated with laser-assisted cataract surgery, and the truth is not everyone needs it or would benefit more medically from it. Always discuss with your cataract surgeon so you can make an informed decision before to surgery.
Visual outcomes: What you can reasonably expect?
Many people assume that the latest technology inherently translates to a better surgical outcome. That cannot be further from the truth. As mentioned earlier, the outcome depends on a myriad of factors, including the surgeon’s skills and pre-operation measurement etc than on whether a laser was used for specific steps during the cataract surgery. Another important factor is the choice of the IOLs.
In Singapore, with the availability of a vast choice of IOLs to choose from, the lens you choose will determine the level of convenience you enjoy post-surgery:
- Monofocal: Good for far distance, but reading glasses are usually needed
- Toric: Corrects astigmatism
- Extended depth-of-focus (EDOF): Provides spectacle freedom for far and intermediate (poor near) or near and intermediate vision (poor far) for most activities. Therefore, offers more convenience than a monofocal
- Trifocal: Provides spectacle freedom for far, near, and intermediate vision for most activities. Therefore, offers the most convenience amongst all IOLs.
Visual expectations, though, must be realistic post-surgery. A cataract treatment in Singapore aims to regain good functional vision by improving clarity, and not to get the ‘perfect’ vision. Glasses may still be needed for some activities, and the use of glasses is not a complication.
Which group may benefit most?
Cataract surgeons in Singapore who are pro laser-assisted cataract surgery may recommend the procedure to those who opt for toric or multifocal IOLs, those with astigmatism or those with denser cataract, citing higher accuracy.
In a nutshell, a surgeon’s expertise, skills, and experience matter the most in any cataract surgery, be it standard or bladeless cataract surgery.
Risks and misconceptions
In this section, we look at common myths surrounding laser-assisted cataract surgery.
Myth 1: “Laser means no cuts at all.”
Bladeless cataract surgery involves the use of a femtosecond laser to replace only certain manual steps in a cataract surgery. Incisions and openings are still part of the procedure.
Myth 2: “Laser surgery is completely risk-free.”
Both standard and laser-assisted cataract surgery are widely performed and considered to be generally safe procedures. It is low-risk, not no-risk, and the possible risks and complications, albeit uncommon, include:
- Infection
- Endophthalmitis
- Retina complications (detachment, retinal swelling)
- Iris complications
- High eye pressure
- Cornea complications ( swelling of the cornea, detachment of the inner layer of the cornea, cornea decompensation)
The use of a femtosecond laser in a cataract surgery does not eradicate the above risks.
Myth 3: “Laser-assisted cataract surgery guarantees better vision.”
This is uncertain as the final surgical outcome is dependent on a range of factors like choice of IOL, pre-existing eye conditions/diseases, surgical planning, and how one’s eye heals post-surgery.
The laser may improve accuracy in certain steps, — but it is unable to guarantee better vision.
Myth 4: “If I do not choose laser, I am getting outdated surgery.”
The reality is such that standard cataract surgery (phacoemulsification) remains the mainstay internationally, and millions of people opt for this method yearly. Many experienced and skilful cataract surgeons still swear by standard cataract surgery and continue to achieve good outcomes.
The decision factors
When choosing which eye surgeon and which eye centre to choose from when considering cataract treatment in Singapore, it is prudent to check on:
- Surgeon’s experience in terms of surgical volume as his/her expertise, outweighs the method of surgery.
- Location of surgery to ensure it is performed at a licensed ambulatory surgery centre or a hospital-approved operating theatre.
- The range of diagnostic equipment provided at the chosen eye centre
- If you can gain quick access to the surgeon post-surgery in case of emergency, and that long term follow-up care is possible.
Cataract surgery fees in Singapore
The main factors that may drive up costs include the seniority of the surgeon, the type of IOL chosen, the location of surgery performed, whether an anaesthetist is required, and technology (standard vs laser-assisted).
In Singapore, cataract is considered an eye disease. Hence, it is MediSave- and insurance-claimable when applicable.
Before cataract surgery, be sure to ask for a full breakdown of all fees involved in the surgery (pre- and post-), check on coverage with your insurance provider, and what is claimable from MediSave. The general advice is not to go straight for the cheapest option as you should invest in long-term vision and eye care.
If you only need to remember one thing
The choice of surgeon and IOL matters more than whether you opt for standard vs laser-assisted cataract surgery.
The best way to evaluate this is to have a cataract screening. Through a face-to-face consultation, your cataract surgeon will be able to provide you with a full understanding of your surgical options based on your specific eye condition. To schedule for one, please contact Lang Eye Centre at [email protected] or +65 6684 1000.
