Almost 600,2015 Italians underwent cataract surgery in <>. In practice, every year, in our country, there are more interventions of this type than newborns. And the average age of the operation is falling: the tendency is in fact to resort to surgery before the situation degenerates. Also because it is an operation that guarantees excellent results in terms of safety, with a very limited incidence of complications.
Cataracts between past and present
“Cataract is the name we give to the natural lens of the eye, the crystalline lens, when it becomes opaque,” explains Roberto Bellucci, president of the European Society of Cataract & Refractive Surgeons. “Cataract surgery is increasingly in demand: in our country, almost 600,<> are performed a year. These are high numbers, but still lower than those of other countries, such as the United States or Australia, where there is a tendency to operate earlier, when the opacification of the lens is not yet complete.
Only 30 years ago, the situation was very different. The typical patient was between 80 and 90 years old, while today he is between 60 and 70 years old. People of retirement age, therefore, but who still claim an active role in society and want to be at their best from a physical point of view, even improving their visual skills.
No more glasses
Several factors have contributed to lowering the average age of the operation, including the fact that today surgery offers excellent results in terms of visual rehabilitation, often allowing vision without glasses in the post-operative period.
Thanks to the technological developments of recent years, in fact, it is possible, together with cataract surgery, to apply artificial crystalline lenses with complex optics, which serve to correct annoying visual defects such as astigmatism, presbyopia and myopia.
“There are artificial crystalline lenses,” he continues, “that allow you to correct astigmatism, thus freeing the operated patient from the need to always wear glasses.”
A separate chapter is that of presbyopia, that is, the difficulty in seeing closely. Those who undergo an operation in a public facility can only obtain a standard artificial lens, which does not solve the problem. And he must wear corrective glasses even after the operation. “High technology now offers us multifocal crystalline lenses, which allow us to see far and near without glasses in most cases. Unfortunately, they are rarely used mainly due to cost problems» explains the expert. In these cases, the only chance is to go to a private clinic, paying out of your own pocket the money necessary for the operation.
What does the operation consist of?
The standard intervention, the one currently guaranteed by the National Health Service, involves anesthesia in drops, then an incision of about three millimeters on the wall of the eye, and then the crushing of the cataract lens (which has a diameter of 9 millimeters and a thickness of about 4) through an ultrasound device called a phacoemulsifier.
“Once the cataract has been removed and the residual household effects have been aspirated for complete cleaning, a replacement artificial lens is inserted into the eye, transparent and unalterable over time,” Bellucci points out. “By acting on the dioptric power of this artificial lens,” he adds, “it is possible to correct pre-existing visual defects.”
The safety of the operation is very high: it exceeds 99%. “One of the most serious problems, the post-operative infection,” concludes the ophthalmologist, “has been almost completely eliminated by recent sterility and disinfection procedures. The European Society of Refractive and Cataract Surgery conducted a European multicenter study that demonstrated how adequate preoperative and intraoperative prophylaxis with disinfectants and antibiotics reduces infectious complications to one case in 12,000 operations.
The advantages of the new all-laser technique
Cataract surgery, already extremely effective and safe with conventional techniques, has achieved further improvement thanks to the combined use of the nanolaser and femtolaser system in the all-laser technique for crystalline fragmentation, which can replace ultrasound phacoemulsification, with less energy dispersion and greater respect for the internal structures of the eye.
“This new technology,” explains Leonardo Mastropasqua, national president of the Society of University Ophthalmologists (OU), “can replace the phacoemulsification technique in conventional surgery and can be used as a complement to cataract surgery with femtolaser.”
The advantages are not few: the very short duration of the laser pulse and the very low pulse energy translate into less heat production at the level of the ocular tissues. “The lower amount of energy released inside the eye causes above all less damage to the cornea and less inflammation of the retina” highlights Mastropasqua.
In addition, the rounded tip of the nanolaser system, unlike the sharp tip of the traditional ultrasound system, greatly reduces the risk of damage inside the eye during surgery, and the disposable handpiece of the laser system decreases the risk of eye infections. Internationally, there are case studies of patients treated with nanosecond lasers for cataract surgery that demonstrate the safety and efficacy of the nanolaser system compared to traditional phacoemulsification.
“The combination of the nanolaser and the femtolaser,” comments the expert, “further optimizes the results with rapid visual recovery of the patient: in this all-laser procedure the advantages of the two techniques are associated, with the result of an improvement in vision, linked to the precision of the incisions made with the femtolaser, and a reduction in ocular thermal damage obtained with the zeroing of ultrasounds”.
The method is supplied to the National Center for Robotic Surgery of the University “G. d’Annunzio” of Chieti-Pescara and patients, if suitable for treatment, can undergo cataract surgery with combined laser technique as an alternative to classical treatment. “The all-laser technique can be used in all types of cataracts and in particular in complicated cases,” he concludes, “such as post-traumatic cataracts, cataracts in subluxated crystalline lenses, i.e. dislocated with respect to their normal position inside the eye, and finally polar cataracts, whose extraction involves a high risk of intraoperative complications”.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.