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Cataract Surgery

    What is cataract?

    Humans gradually realize that it is hard to see near when we were around 40 years old.
    This is because when you were young, you could adjust the focus by changing the thickness of the lens, but as you age, the focus adjustment function declines.
    Recently, it seems that the time to become aware of presbyopia tends to be younger due to the increase in the usage time of personal computers, smartphones, and tablets.

  • What is cataract?

    Cataract is a disease in which the originally transparent crystalline lens becomes cloudy in grayish white or brown.
    The lens acts as a camera lens and has the function of refracting light coming in from the outside to focus on the retina, which is a very important tissue for seeing things.
    The lens is made up of water and protein, which gradually denatures and becomes cloudy due to oxidative stress such as aging and long-term exposure to ultraviolet rays.

    Illustration of cataract eye
    Illustration of normal eyes
    Provided by : Japan Archon Co., Ltd.
  • Causes of cataracts

    Cataracts are congenital, associated with systemic diseases such as diabetes and atopy, associated with uveitis, side effects of drugs such as steroids, and those that occur after eye surgery such as retinal detachment and fundus hemorrhage. There are various things such as those caused by trauma, but the majority are caused by aging.
    Age-related cataracts increase in risk with age from the late 40s, with 40-50% in the 50s, 70-80% in the 60s, and 80-90% in the 70s, this is a disease that most people will get.

    Incidence rate graph of cataract by age
    Incidence rate graph of cataract by age
  • Classification by opaque part of the lens

    Anterior subcapsular cataract: A type in which turbidity appears under the anterior capsule of the crystalline lens
    Cortical cataract: A type in which turbidity appears in the cortex closer to the center than the lens sac
    Nuclear cataract: A type in which the nucleus in the central part of the crystalline lens becomes cloudy
    Posterior subcapsular cataract: A type in which turbidity appears in front of the posterior capsule of the crystalline lens

    Illustration of anterior subcapsular cataract

    Anterior subcapsular cataract

    Illustration of cortical cataract

    cortical cataract

    Illustration of nuclear cataract

    nuclear cataract

    Illustration of subcapsular (posterior subcapsular) cataract

    subcapsular (posterior subcapsular) cataract

  • Cataract symptoms

    Symptoms of cataracts are typically hazy, blurry and double-looking, and poor eyesight, but there are also symptoms that are easy to get tired, dazzling in bright places, and bleeding at night.
    As cataracts progress, not only do they become hazy and their eyesight deteriorates, but they also develop myopia and become difficult to see even when wearing glasses or contact lenses.
    Cataracts usually progress slowly, so it often has few subjective symptoms and is unaware in the early stages, or even if one eye has cataracts and his eyesight is impaired, he is often unaware that the other eye is visible.
    Whether or not you have cataracts cannot be determined from the subjective symptoms of the person, so it is often found only after seeing an ophthalmologist due to poor eyesight at a medical examination.

    Double vision

    The image of the scene looks double

    dazzling

    Dazzling image in a bright place

    halo

    Image of night light blurring
  • Prevention and treatment of cataracts

    1. Prevention of cataract

    Cataracts are caused by oxidative stress degeneration of crystalline lens proteins, so when you go out, use sunglasses, a wide-brimmed hat, a sunshade, etc. to prevent ultraviolet rays from entering your eyes, take care of eye strain, rest your eyes. Preventing lifestyle-related diseases such as diabetes and diabetes, actively ingesting vegetables and fruits containing vitamin E, B2 and C, eating a balanced diet, and quitting smoking to prevent oxidative stress and delay the occurrence of cataracts.

    Woman with a parasol
    Sunglasses that protect against UV rays
    Vegetables and fruits that prevent oxidative stress

    2. Eye drop treatment for cataract

    In the early stages of cataract, medication may be given with eye drops (Cataline®, Curry Uni®, Tathione®, etc.).
    These eye drops are said to have the effect of slowing the progression of cataracts by inhibiting protein denaturation of the crystalline lens, but it is currently no cure for cataracts.
    In other words, the turbidity of the crystalline lens does not return to its original state, so when cataracts occur, surgery is performed to replace the turbid crystalline lens with an intraocular lens, which is an artificial crystalline lens.

    woman putting eye drops in her eyes
    (*)
    Eyedrops: CATARIN
    Eyedrops: KARIYUNI
    Eyedrops: TACHION
    (*)Copyright: Santen Pharmaceutical Co., Ltd.

    3. Types and characteristics of intraocular lenses used for cataract surgery

    1. Mono-focal intraocular lens and multifocal intraocular lens

    Intraocular lenses used during cataract surgery include mono-focal intraocular lenses and multifocal intraocular lenses. The only lens that can be used in normal medical insurance is a mono-focal intraocular lens, and if you adjust the distance so that you can see it with the naked eye after surgery, you will need reading glasses for the near side, and conversely, if you adjust it so that the near side can be seen with the naked eye. Myopia glasses are required in the distance.

  • Intraocular lens selection
    (mono focal / multi focal)

    Monofocal lens:One focus distance
    Multifocal lens: Multiple in-focus distances
    Provided by : Japan Archon Co., Ltd.

    2. Advanced medical care and evaluation medical treatment

    Until March 2020, it was possible to perform surgery using some multifocal intraocular lenses in highly advanced medical care (life insurance benefits can be obtained and the actual burden is small), but after April Since cataract surgery for multifocal intraocular lenses has been removed from advanced medical care, it is now possible to use some multifocal intraocular lenses for evaluation treatment (additional charge similar to differential betting).

    3. Non-insurance multifocal intraocular lens

    Non-insurance cataract surgery is expensive, but it can be done with state-of-the-art laser cataract surgery, which uses a laser without a scalpel, and all types of intraocular lenses are also state-of-the-art.
    Non-insurance cataract surgery can treat not only myopia, hyperopia, and astigmatism but also presbyopia.
    In addition, some lenses are completely made-to-order, and the power of the lens is highly accurate according to each eye (as opposed to normal intraocular lenses, which are corrected in 0.50D units like eyeglasses and contact lenses. It is possible to create and use a lens with 50 times higher accuracy (correction in 0.01D units is possible).

    Intensity
    Intensity of multifocal intraocular lens

    With five focal points, a smooth and continuous view can be obtained from far to near.

    FINE VISION
    FINE_VISION of multifocal intraocular lens

    The focus is far, medium, and near.
    Most proven in multifocal intraocular lenses. (compared to our hospital)
    Nighttime halo and glare can be reduced.

    LENTIS Mplus X
    Multifocal intraocular lens LENTIS_Mplus X

    You can see far and near with a bifocal lens.
    It can correct the strongest myopia and can be made to order even for myopia and astigmatism.
    Good eyesight is obtained even with mild glaucoma and macular disease.

LASIK and cataract surgery

Cataract surgery can be done with exactly the same procedure as those who have LASIK surgery or not. However, those who have LASIK often refuse to have cataract surgery at a nearby doctor.
The reason is that after LASIK, the thickness and curve of the cornea have changed, making it difficult to calculate the power of the intraocular lens that is inserted after removing the white turbid crystalline lens.
The power of the intraocular lens used in cataract surgery is calculated by the length of the eye and the curve of the cornea, but after LASIK, the calculation formula shifts, and in many cases hyperopia occurs and you can’t get the target naked-eye visual acuity is achieved.
In recent years, various new calculation formulas have been used, and the deviation of the intraocular lens after LASIK has been eliminated. However, if the intraocular lens still does not have the power after LASIK, the intraocular lens may be replaced. LASIK reoperation is required.
In addition, when using a multifocal intraocular lens for cataract surgery so that it can be seen with the naked eye from both perspectives after surgery, more accurate intraocular lens power calculation is required.
For this reason, post-LASIK cataract surgery requires extensive experience in both refractive surgery and cataract surgery. Yoshihiro Kitazawa, who is in charge of the operation of this clinic, has abundant experience and skills in both surgical procedures, with about 25,000 cases of cataract surgery and about 50,000 cases of laser refractive surgery. So please feel free to contact us first.
We will explain the optimal surgical method for each eye through detailed examination by an orthoptist and examination by an experienced ophthalmologist.

IOL calculation graph

    What is Laser Cataract Surgery?

  • What is laser cataract surgery?

    In conventional cataract surgery, the surgeon manually performs the entire process of creating a wound, incising the anterior capsule (transparent shell) of the crystalline lens, dividing the nucleus of the crystalline lens, ultrasonically emulsifying and aspirating the crystalline lens, and inserting an intraocular lens.
    Therefore, the operation time varies from a few minutes to 20 minutes depending on the skill of the surgeon, and the postoperative results also differ depending on the surgical invasion.
    On the other hand, laser cataract surgery performs from the first wound incision to the anterior capsule incision of the crystalline lens and nuclear division with a laser, which makes it possible to perform surgery that is as beautiful as or better than a surgeon who excels in cataract surgery.
    And above all, it is a laser surgery that does not use a scalpel, so there is an advantage that patients can undergo surgery with peace of mind.
    As will be described in detail in the section on benefits, laser cataract surgery has the advantage of maximizing the effects of multifocal intraocular lenses.

    Comparison of traditional cataract surgery and laser cataract surgery
    Provided by : Japan Archon Co., Ltd.
  • Indications for laser cataract surgery

    All cataracts are indicated for cataract surgery using a laser.
    Whether it is the cause of comorbid cataracts such as atopic diseases and diabetes, or traumatic cataracts, it is mainly age-related cataracts, even if the type of opacity is different, such as anterior capsule cataract, cortical cataract, nuclear Cataract and posterior cystic cataract can be undergo this surgery.
    With lasers, you can safely undergo surgery from mild first-onset cataracts to advanced nuclear cataracts and overripe cataracts.
    Another advantage is that lasers can be used with confidence even in cases of superficial anterior chamber, overripe cataract, and vulnerable Chin's band, which were at risk in conventional manual surgery.

    A case of cataract

    Illustration of immature cataract
    Illustration of mature cataract
    Illustration of overripe cataract
  • Laser cataract surgery process

    STEP 1 Anesthetic
    Laser cataract surgery process STEP1 Anesthesia

    Only ophthalmic anesthetics (eye drops) are used to induce anesthesia.

    STEP 2 Initial incision made
    Laser cataract surgery process STEP2 Make an incision

    Scan the eye three-dimensionally and create a wound (2.2mm-2.6mm) with very high accuracy

    STEP 3 Incision made in the crystalline structure shell (anterior capsulotomy)
    Laser cataract surgery process STEP3 Capsulotomy

    Using the laser, a highly accurate incision is made based on image analysis. The method yields greater accuracy than yield with a trained ophthalmologist using a scalpel.

    STEP 4 Hardened core of the crystalline lens is crushed (Nuclear division)
    Laser cataract surgery process STEP4 Crushing the hard core of the crystalline lens

    A laser is used to finely crush the nucleus of the lens that become cloudy and brittle

    STEP 5 Cortex suction
    Laser cataract surgery process STEP5 Phacoemulsification

    The crushed lens nucleus and the tissue of the surrounding area are suctioned off.

    STEP 6 Prosthetic lens is inserted in the eye
    Laser cataract surgery process STEP6 Insert intraocular lens

    The multifocal intraocular lens is inserted into the clear shell that remains.

    *Intraocular lens
    adopted in our hospital

    ・Multifocal intraocular lens:
      Trifocal lens: Fine vision (PhysIOL)
      Bifocal lens: LENTIS Mplus X (Oculentis)
    ・Multifocal lens for astigmatism correction:
      Trifocal lens: Fine vision Toric (PhysIOL)
      Two focus lenses: LENTIS Mplus X Toric (Oculentis)

    Intraocular lens adopted in our hospital

    It is possible to correct not only myopia, hyperopia and astigmatism but also presbyopia.
    In our hospital, we select the lens most suitable for the patients request and condition.

  • Flow to laser cataract surgery

    ① First visit reservation using the online booking form
    Please select your desired date and time.
    ② Receive an email confirmation of first appointment reservation
    ③ Initial indication examination with limited wearing of contact lens
    Do not wear soft contact lenses for 3 days before your examination, and stop wearing hard-or continuous wear contact lenses for 2 weeks before your examination.
    If you have follow the wearing contact lenses limitation, please contact us.
    If you are receiving treatment at another department, please bring your doctor's medical information provision form.
    In order to check if you are eligible for surgery, we will examine your eyes and also check for eye diseases. You will not be able to drive a car after the eye examination (the pupil is dilated with eye drops and then examined).
    Since mydriasis (dilating the eyes with eye drops for inspection) and fundus examination is performed, you cannot drive a car for 3 to 4 hours after the examination.
    Please note that it will be difficult to see nearby.
    After the indication test, you will be examined by an ophthalmologist certified by the Japanese Ophthalmological Society, and we will show you the current eye condition, details of laser cataract surgery, and recommended multifocal intraocular lenses for that person.
    You may ask questions or concerns you may have to us and our Ophthalmologists who are certified by the Japanese Ophthalmologist Society or one-on-one counseling.
    ⑤ On the day of surgery for one eye
    Contact lenses can be worn until the day before surgery, but please visit us wearing glasses on the surgery day.
    You can go home alone after the surgery, but please be careful as you will be wearing an eyepatch on the day of the surgery.
    If you are worried about returning home alone, we recommend that you bring your family with you.
    I don't have any pain because I have an eyepatch, but I feel awkward and heavy, so go home early and rest your eyes.
    ⑥ Examination of the next day after surgery and surgery for another eye
    We will remove the eyepatch after your visit, it looks a little blurry but pretty clear.
    After the eye surgery that was performed yesterday, you will have another eye surgery, and you will be asked to wear an eyepatch and return home as you did the day before.
    Eye drops are very important from the day after surgery, so use them firmly.
    ⑦ Postoperative examination
    After your visit, the eyepatch will be removed and both eyes will be examined.
    Start instilling protective sunglasses as soon as you wake up from this day.

Merits and Demerits

Merits of laser Cataract Surgery

■Accurate and safe surgery customized for each patient
Because the difficult aspects of the operation are performed with an automated laser, we are able to offer customized procedures in accordance with pre-operative plans.
Furthermore, because they conform to a patient’s specific needs, our procedures are rendered more accurate and safer.
■Reducing any burden on the structure of the eye to facilitate rapid post-operative recovery and visual stability
Cataract surgery incorporates the use of ultrasound to clear the cloudiness of the eye’s crystalline lens that occurs with the condition.
By employing a laser, we are able to create a partition the clouded crystalline structure prior to the use of ultrasound, thereby effectively reducing the amount of ultrasound energy required to clear the structure.
The result a much smaller impact on the structure of the eye. Reducing the burden on the eye facilitates more stable vision and rapid recovery.
■Creating a perfectly round, distortion-free shape maximizes the features of implantable prosthetic lenses
Implantation of a multifocal lens is a very delicate operation in terms of lens placement and other factors.The use of surgical lasers enables the creation of a perfectly round shape, free of any distortion, for the anterior capsulotomy. This is a critical aspect of the procedure that is difficult to accomplish manually.
This is enable to maximize the functionality of the multifocal intraocular lens and ensure stable results.
■Undistorted, round anterior capsule incision reduces the risk of late cataract
Cataract surgery can sometimes result in late cataracts, where the posterior capsule of the inserted intraocular lens becomes cloudy and vision is impaired.
Visual acuity can be restored by removing the turbid film with a laser called YAG laser, but late cataract depends on the beauty of the anterior capsule incision (whether it is centered in a perfect circle and whether it covers the entire lens)
Laser cataract surgery can also reduce the risk of late-onset cataracts by making a round, undistorted anterior capsule incision.
■ Safe and reliable surgery even in difficult cases
Laser can safely and reliably perform anterior chamber incision even in cases of overripe cataract, fragile Chin's band, and superficial anterior chamber, which were difficult with conventional manual surgery.
In addition, even in advanced nuclear cataracts where the ultrasonic energy becomes high and the invasion to the eye becomes strong, the energy used can be reduced and the burden on the eye can be reduced by pre-dividing the nucleus with a laser.

Demerits of laser Cataract Surgery

■Surgery costs
The health insurance does cover this surgery, the state-of-the-art laser is used, and the multifocal intraocular lens is tailor-made to meet the patient's wishes. The cost of the procedure is higher than that for conventional cataract surgery.
■Time required for the operation
This operation requires slightly more time than that required for a conventional laser surgery because laser application is incorporated into the process.
Normal cataract surgery takes a few minutes per eye, but LASER cataract surgery takes about 10 minutes per eye.
■There may be bleeding due to the device
A special device is attached to the conjunctiva (white portion of the eye) to hold the eyeball in place as the laser is applied.
Due to the suction applied to immobilize the eye, some patients may experience bleeding. Any such bleeding has no impact on vision, resolving itself in a matter of days.
However, this bleeding is also naturally absorbed in a week or two.
■Eye drops and care before and after surgery are important
Laser cataract surgery is less burdensome to the eye than regular cataract surgery, but it also causes hyperemia and inflammation, and if you neglect to apply eye drops, the risk of infection is not zero.
It is important to follow the precautions such as eye drops before and after surgery and lifestyle restrictions.

Laser Cataract Surgery costs

Costs
Fine Vision, LENTIS MplusX without astigmatism correction
Both eyes: 1,500,000 yen, Half price for one eye

Fine Vision, LENTIS MplusX with astigmatism correction
Both eyes: 1,600,000 yen, Half price for one eye
※costs are not covered by Japan's National Health insurance.
※a deposit of 300,000 yen is required.
Installment price list for laser cataract surgery (surgery costs 1.5 million yen) Installment price list for laser cataract surgery (surgery costs 1.5 million yen)

※For those who wish to apply for a medical loan, please notify us by the second pre-surgical medical examination.

Warranty period
3 years
Capsulotomy following YAG laser procedure: free of charge
It will be free of charge for 3 years after the operation, and will be covered by insurance after 3 years.
※Additional correction by LASIK is 200,000 yen including tax for both eyes (100,000 yen including tax for one eye).
Postoperative examination
the day after surgery / 1 week / 1 month / 3 months
The warranty is 3 years; thus, please visit us in 6 months, 1 year, or 3 years if you wish. After 3 years, the examination will be covered by medical insurance.

About Laser Cataract Surgery