Laser cataract surgery is now accessible to more patients around Australia, following the arrival of Capsulaser.
Developed in the United States, Capsulaser is an alternative to Femtosecond-Laser-Assisted Cataract Surgery (FLACS), that comes at less than 30% of the cost and offers a predictable capsule opening. It can be seamlessly integrated into current cataract surgery, offering many of the benefits of FLACS but eliminating the need for a two-staged procedure, saving clinicians time and resources.
Brisbane eye surgery clinic, OKKO Eye Specialist Centre, was the first Australian business to install the Capsulaser device and ophthalmic surgeon/ OKKO founder Dr Matthew Russell, says this is the first time people have had access to any form of laser cataract surgery in his city.
“FLACS was available on the Gold Coast, but until now, people in Brisbane have not had access to laser cataract surgery locally – we’re thrilled to be making this state-ofthe- art technology available to those who need to undergo cataract surgery or refractive lensectomy treatment,” Dr Russell said.
“For me, the key difference with Capuslaser (as compared to traditional phacoemulsion) is the ability to use it to implant the Femtis extended depth of focus intraocular lens (EDOF IOL), which is the only EDOF IOL available in Australia specifically designed for laser assisted cataract surgery that is implanted into the capsular opening,” Dr Russell explained.
“Implanting in the capsular opening (the anterior capsulorhexis), as opposed to the capsular bag enables us to achieve stable, predictable visual outcomes. We can more accurately position the lens on the visual access and be confident that it will remain in place post-surgery. When implanting toric lenses for astigmatism, the chance of rotation after surgery is also reduced. This is important because we know that any decentration leads to side effects and impacts the visual outcome and quality of vision,” he said.
Dr Russell also finds that Capsulaser facilitates more predictable results when implanting multifocal IOLs because it enables precise construction of the rhexis, and reduces its risk of overlapping the optics, which can cause the lens to become decentred post-surgery.
“So, the big thing about Capulaser is accessibility – where the cost of femtosecond laser made capsulotomy prohibitive for many day surgeries, Capsulaser’s affordability means surgeons and patients can now take advantage of this new technology to implant EDOF and multifocal lenses that provide the range of vision many patients want and expect.”
Dr Russell said there were no unexpected challenges associated with using Capsulaser. Patients who are unsuitable are those whose pupil does not dilate well and those who need to be heavily sedated.
“Surgeons in Australia usually prefer to have their patient quite sedated for cataract surgery. However, to get the best lens alignment with Capuslaser, we need minimal sedation – the patient needs to align their vision with the target beam for the third of a second required for the procedure,” he explained. “While there is a device to keep the patient’s lens still, we can’t be confident the head will remain still if they are fully sedated.”
UNEXPECTED BENEFITS
A surprise find was that Capsulaser is beneficial for patients with dense cataracts and white cataracts due to its “ease and speed and the strong capsular edge that results from the heat effect of the laser on the collagen of the capsule”. While these patients typically represent just 1-2% of those coming through Dr Russell’s day surgery, he said being able to offer then laser is beneficial because they are at very high risk of complication or tear.
For regular cataract patients he said, “The technology significantly increases patient comfort compared to FLACS surgery and improves IOL stability compared to in the- bag monofocal IOL implantation in standard cataract surgery. It also increases the predictability of patients’ vision outcomes, particularly when implanting toric IOLs”.
The laser precision allows surgeons to preselect the intended capsulotomy size from 4.0mm to 5.5mm in 0.1mm increments, allowing for consistent capsulotomies during every surgery. The single, smooth laser cut, combined with its heat effect on collagen, means the resulting capsular edge is much stronger than the serrated edge created with a femtosecond laser, which potentially makes the procedure safer. The edge of the capsulotomy is very visible during the entire procedure, much more so than following FLACS or manual capsularhexis.
“Our experience so far suggests that Capsulaser may be safer than current laser cataract surgery. However, this will need to be evaluated formally in longer-term studies,” Dr Russell concluded.
