Newer pathways to precision in cataract surgeries

Recently, I was invited to participate in the Asia Pacific Association of Cataract and Refractive Surgeons’ meeting held in Kuala Lumpur, Malaysia, as a speaker. The central theme of the meeting was exploring new horizons and the continuous strive for improvement. One of the topics that I spoke about and which I personally believe to be crucial was – ‘ways to improve the precision in cataract management’.

In today’s modern times, it is absolutely necessary to focus on enhanced precision and safety owing to the changing lifestyles and patients’ higher expectations.

I also got the opportunity of sharing REH’s unique approach of preoperative management for cataract surgeries. A detailed preoperative diagnosis is usually carried one or two days prior to the surgery where the patient’s eye is examined carefully using state of the art investigative technologies.


  1. Determining the type & degree of cataract, the presence of any other existing eye conditions (comorbidities), assessing the ocular surface and the lid margins for the lubricating mechanisms.
  2. The profile of the front and back surface of cornea is studied in detail using Keratometry, Topography, Schliemflung photography and a revolutionary new technology using a Laser Light Ray Tracing which measures the optical properties of the cornea and other vision degrading influences in the entire eye.
  3. The health of the cornea is then studied using a procedure called Specular microscopy.
  4. A thorough retinal evaluation including Retinal tomography (OCT) which helps to further understand the micro details of the retina, thereby predicting the visual outcome.
  5. The patient’s overall health profile, requirements, profession, hobbies and personality are also carefully studied and the patient is suggested about the ideal choice of IOL suited for his individual needs and lifestyle requirements.

The results of all these examinations are taken into consideration to formulate a final surgical plan which includes the chosen surgical technique and the type of IOL to be used. The surgery is then performed according to the surgical plan by our expert surgical team using the advanced image guided laser technology to ensure precision and safety of the patient. I was also able to establish that the most promising effect of REH’s approach is the fact that by carefully examining the patient’s lifestyle and his eye profile we are able to customise the solution according to his individual needs and thereby enhance the quality of his lifestyle.

Additionally, with the aid of REH’s surgical videos, I was able to reinforce the fact that controlling intraocular pressure during the cataract removal gives the surgeon a greater level of control. Some of the newer technologies can give the surgeon ‘Cruise Control’ during the cataract surgery, thereby enabling him to further refine the surgical performance.

In the past, we had published 2 eye-opening clinical studies using these newer technologies. These were published in the peer reviewed Journal of Cataract & Refractive Surgery, Journal of Refractive Surgery and showed that our strategy of keeping the machine settings to an optimum level improved the safety and precision during cataract removal. When we compared the outcomes to that of traditional machines and settings, we had discovered that our strategy led to minimized complications and improved precision in results. These results have prompted many surgeons across the globe to adopt this strategy. Many of them discovered that this technique is particularly useful when treating complicated and challenging cataracts. It also enables the surgeons to ensure that patients with various complicated comorbidities are treated with increased safety and precision. Prescheduled follow-up visits and regularly monitoring the patient is of prime importance to ensure ideal outcomes.

During the meeting, the importance of various image guided technologies for preoperative, intraoperative and postoperative assessment was further highlighted by Dr. Hiroko Bissen – Miyajima from Japan and Dr. Fan Han Bar from Singapore. Dr. Thomas Kohnen from Germany also explained how the laser assist cataract surgery has improved the precision and safety for the patients. The faculty present also echoed the need to adopt precision at all the stages of cataract management.