A wide range of current techniques and scientific research is currently being used in laser-assisted cataract surgery. Most of the talk is of a femto phaco. There are several femtosecond lasers from different manufacturers competing for this application.
What they all have in common is the goal of achieving greater accuracy in cutting the area around the cornea. In addition, a capsulorhexis optimized in roundness and diameter-in comparison to the manual procedure-can be achieved. Furthermore, the devices want to score with the option of lens-core fragmentation. This should make it possible to significantly reduce the ultrasound energy during surgery.
In many current studies, the certainly impressive technical achievements of the laser systems are discussed. However, it has not yet been clarified which patients are the most pro-fit for a laser-assisted surgery. Here, too, the enormous initial costs of such systems must always be balanced with the question of significant improvements for patients.
Cataract surgery and artificial lens implantation have made far-reaching progress in recent years. Only a few ambitious operations centers still offer the full range of modern procedures and techniques. However, it is foreseeable that the patients are talking about which possibilities for improvement the new so-called premium IOLs bring with them.
In most surgical centers, the objective of treatment is the removal or replacement of the clouded lens by an artificial lens. The optical rehabilitation of the operated patients is then left to the optician, z. By progressive lenses because of persistent presbyopia or by astigmatism-correcting glasses when a spherical IOL has been implanted, although there is a corneal astigmatism. The surgeon and the patient were satisfied with a target refraction of ± 2.0 diopters and left the rest to the optician. In fact, completely incomprehensible, considering that there is a decade-long professional dispute over the question of who the refraction should be left to the ophthalmologist or optometrist.
Premium IOLs offer the opportunity to use the cataract surgery to perform an IOL that in many cases eliminates the need to wear glasses – or at least significantly improves uncorrected vision, significantly reducing reliance on glasses. A competence advantage on the part of the medical profession, which is no longer substitutable. Even the statutory health insurance companies have recognized the trend and implemented the legal basis on the basis of a copayment scheme. Surgeon, conservative ophthalmologist and patients benefit from this scheme.
But is it just to pick another IOL? Certainly not. Anyone who gives their patients the chance to expect more than the conventional one is in the “blame.” Which premium IOL for which patient? This is the crucial question: The ophthalmologist has to take care of the patient much more intensively Not every patient is suitable for multifocal IOLs For example, if you use an aspheric IOL, you must of course know the asphericity of the cornea, otherwise it may happen that you do not neutralize it as you intended reinforced and thus creates problems.
The same applies to multifocal IOL. There are numerous exclusion criteria for multifocal IOLs. Whether it is that the cornea of the eye to be treated to excessive aberrations or the Endothelzellzahl insufficient and the transparency of the cornea is not optimal. How to calculate and plan the implantation of toric IOL and how to check the postoperative position of the intraocular IOL torus? When refractive surgery becomes part of curative cataract surgery, it becomes complicated and demanding – both for the surgeon and the postoperative ophthalmologist.
At least that’s the way it seems.
Premium diagnostics for premium patients
Parallel to the development of the premium IOL, a lot has also been done in diagnostics. The armentarium of diagnostic equipment has become almost unmanageable. Therefore, it is of great importance for the surgeon and the conservative ophthalmologist to identify what is really necessary and how to achieve this with as few supplementary equipment as possible in a time-saving, as delegable as possible, but reliable and meaningful. Diagnostic systems should be able to communicate with one another and with higher-level practice software so that data does not have to be entered redundantly. The surgeon should be able to identify the essentials for consultation and strategic planning at the end of the preliminary examination with a view of the screen. The diagnostic package presented here by OCULUS and NIDEK offers these requirements in the best possible way. The systems are matched to each other and, in total, correspond to what the surgeon needs in an optimal way when planning a premium IOL implantation. But also the advisory and aftercare conservative ophthalmologist, these systems open up new fields of competency presentation and thus a bit to safeguard the future.
The benefits of Pentacam® for selecting and calculating Premium IOL
The Pentacam® is a rotating Scheimpflug camera that provides accurate 3-dimensional measurement of the anterior segment of the eye. With regard to the implantation of premium IOL, inter alia, the teardrop-independent corneal topography, the determination of the corneal total refractive power including the corneal surface or the calculation of the wavefront aberrations of the entire cornea are of interest. Important further measurement data for the
IOL selection and IOL calculation include the anterior chamber depth, pupil diameter, horizontal corneal diameter or kappa angle.
In addition, with the help of modern analysis programs, corneal pathologies such. As a Keratokonus be excluded with the utmost reliability. Corneal anterior surface, corneal surface and pachymetric information are integrated into the Belin / Ambrosio keratoconus recognition and compare these against normative data.
The Cataract Pre-OR Display summarizes key information regarding premium lens implantation so you can decide immediately whether a multifocal lens, a toric IOL or an aspheric IOL is suitable. The IOL calculation can then also be performed directly with the Pentacam®. Linked ray-tracing programs – such as the Okulix software by Dr. med. Preussner – automatically take over the entire corneal topography of the front and back surfaces and then carry out the IOL calculation. In addition to the IOL calculation, a simulation of the post-operative visual impression is also possible. Only the axis length has to be determined additionally.