If you could do Cateract Surgery All Over Again?
Posted , 3 users are following.
Would you bave choosen Laser or Traditional Cateract Surgery? Which has better & safer results?
0 likes, 5 replies
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Notes on If you could do Cateract Surgery All Over Again?
ali58534 dennis39810
Posted
I didn't have cateracts but had presbyopia which is why I had the lens replacement. Laser wouldn't have been any good for m uh condition. Only thinking if having laser to improve distance which has been left a bit blurry. For the improvement I gained for anything close I would have done again.
softwaredev dennis39810
Posted
Do you have a complicated case, like a very advanced mature cataract? In certain cases there does seem to be a proven benefit.
Unfortunately for the typical case, the issue is currently a subject of debate with people on each side of the issue. e.g. if you look at the CRSToday site (Cataract % Refractive Surgery Today) for the Feb 2017 issue you'll see some articles on each side, like "No Thank You" from someone not convinced of its benefits. The larger studies I've seen seem to suggest they are both very safe and fairly comparable, and each merely has *different* risks of complications which are like comparing apples and oranges in tems of deciding which is safer. For most patients, the benefit doesn't seem to have been demonstrated. I used a very experienced surgeon who had a laser but agreed that there was no real benefit in my simple case, that he saw the benefit of the laser as being more for inexperienced surgeons to get consistent results (though they still need to be past the learning curve of having done enough laser surgeries).
Part of the benefit merely seems to be speculative, e.g. we can get these perfectly round incisions which look appealing.. but the question is whether that actually matters in terms of results, and for most patients it hasn't yet proven iself (and there are now people working on low tech cheaper approaches to doing a more circular incision without a laser, if it is a benefit) . That said, the technology is improving all the time. Its not only possible that it will prove itself in the future, but that perhaps a recent software updated leads some laser model to give better results but they merely haven't published or done a study confirming it. Unfortunately most studies aren't done for merely one laser model, but merely lumping all of them together.
I've been in the leading edge computer science world for quite a while and I'm quite familiar with people sometimes latching onto cool new technology because its cool, even if it isn't yet any better than existing technology. Obviously though sometimes new technology is worth it. In my case I actually went to the trouble a couple of years ago of traveling from the US to Europe to get a new model IOL, the Symfony, which wasn't approved in the US yet. So I was an early adopter for that technology,but chose not to use laser cataract surgery.
I'd read in some cases for instance that surgeons can get a feel for how fragile the capsular bag is when they make the initial incisions, which warns them if there is a need to be more catious than usual to prevent tearing the bag. A laser prevents them from getting that feedback. (not that I have a good sense of whether that makes much of a differene to the results, the point was merely that there are some reasons other than cost that some surgeons prefer manual incisions).
I'd suggest either way is safe, I almost went for it. I'd suggest that if the money isn't prohibitive, that the most important thing is finding a good surgeon you trust and if he seems to genuninely think laser is better than to go with it if there isn't reason not to.
dennis39810 softwaredev
Posted
softwaredev... Thanks for your well knowledgeable reply.
Although my Dr said for years that I will someday have cateracts, I just realized the bluriness just 3 weeks ago in one eye & was diagnosed with a cateract ready for surgery. I jcan not read the small print in this post on a large computer monitor but can read the larger "Your reply to dennis39810" type above. Not sure if this is considered a very advanced cateract.
Thanks for your mention of CRS it seems to be a great resource for me to investigate.
My current Dr is basically not doing surgery anymore. I got a great recommendation from him for a traditional surgeon in his practice, as well as a confirmation from a local O.D.. Although this traditional surgeon is not as high profile & reviewed as much as the laser surgeons I researched, his limited reviews were 5 star.
Saying that I started researching on the web (including this forum) which is the better way to go traditional or laser surgery & until your reply have not received any concrete evidence other then the hype (perfect circle cut, less energy etc). You think one would be unquestionably better then the other. The additional cost for laser is not a consideration.
I have found 4 highly regarded, experienced laser surgeons with good reviews & reports in my NYC, North NJ area.
Trying to make a knowledgeable choice for my best outcomes between top laser surgeon & a top traditional surgeon.
softwaredev dennis39810
Posted
There is a good free ebook by a surgeon that gives an overview of cataract surgery and issues like laser cataract surgery, if you google this:
So, You've Got a Cataract? - David Richardson, MD
You'll see a PDF link for it (they also have hardcopy at Amazon). Although its not fully up to date, his comments seem to match the general impression I have, I've seen nothing to indicate things have changed.
The concerns over a cataract being advanced are likely well beyond what yours is at, like its gotten to the point where you can only see the big E on an eye chart even with their best correction, or perhaps the line below it. If it were very mature, I'm sure they would have said something and commented on how unusual it was to have developed that quickly. The usual guideline is that cataract surgery is covered when best corrected vision is below 20/40, which is the typical driving standard.
CRS Today is a good place to search for info on laser cataract surgery, as is CRS Today Europe, Eyeworld magazine (from an ophthalmology association), Eurotimes (from a European eye doctor association) and Medscape, and EyeWire to name some to get you started that are like trade publications that aren't quite as jargon filled as journal articles. The issue is what the data shows, rather than merely surgeons wishes or anecdotes.
Some surgeons keep statistics on their outcomes, though I'm not sure if you'd have luck asking for them, in terms of the complication rates and visual outcomes. Given the area you are in, I'm sure there are lots of surgeon choices. I tended to figure that surgeons who were asked to do clinical trials for IOL companies or laser manufacturers and others had to be at least competent since they wouldn't want the results tainted by flawed surgical outcomes. I also figured those who were mentioned in trade publications as being on panels or asked to give their opinion in articles were respected for their medical views (even if that says nothing about physical surgical skill), as would be those who were on faculty at med schools. Obviously the surgery is overall very safe, so to some extent its overkill to look for a top surgeon. In my case since I traveled abroad to get a newer lens (back in 2014 before the Symfony was approved here) I was more concerned about it since I'd been warned US standards were higher so to be cautious about surgeons elswhere.
dennis39810 softwaredev
Posted
Thanks again, you outdid yourself... I bookmarked all the publications & will start reading them.