A Guide to Cataract Surgery in Singapore: Choosing the Best Option for You

Cataract surgery is one of the most common and effective procedures performed in Singapore to restore clear vision. With advancements in medical technology, several techniques are available, each with its own benefits and suitability depending on the patient’s eye condition, lifestyle, and preferences. An ophthalmologist can help patients assess these various options and recommend the best one to suit their unique needs.

Types of Cataract Surgery Available in Singapore

Cataract surgery involves removing the clouded lens and replacing it with an artificial intraocular lens (IOL). The following are the primary methods used in Singapore:

1. Phacoemulsification

Phacoemulsification, often referred to as “phaco,” is the most widely used method for cataract surgery in Singapore. This technique involves making a small incision (typically 2-3 mm) in the cornea. An ultrasound probe is inserted to break up the cloudy lens into tiny fragments, which are then suctioned out. A foldable IOL is implanted through the same small incision, which requires no stitches and promotes faster healing.

• Benefits: Quick recovery, minimal discomfort, and low risk of complications. The procedure typically takes less than 30 minutes and is performed under local anaesthesia as a day surgery.
• Suitability: This technique is ideal for most patients with cataracts, particularly those with less advanced cataracts.
• Considerations: This method may not be effective for extremely dense cataracts, as the ultrasound energy may be insufficient to break them down.

2. Laser-assisted Cataract Surgery (LACS)

Laser-assisted cataract surgery (LACS), also known as femtosecond laser-assisted cataract surgery (FLACS), uses advanced laser technology to perform key steps of the procedure. This procedure begins with the laser creating precise incisions in the cornea, opening the lens capsule, and fragmenting the cataract. This allows the surgeon to easily remove the cataract with ultrasound, much like in conventional surgery.

• Benefits: The use of laser technology offers greater precision, potentially reducing astigmatism and improving IOL placement accuracy. It may also lead to faster visual rehabilitation and fewer complications.
• Suitability: This method is best for patients with astigmatism, those seeking premium IOLs, or those with complex eye conditions requiring high precision.
• Considerations: LACS is more expensive than phacoemulsification and may not be covered by all insurance plans.

3. Extracapsular Cataract Extraction (ECCE)

Extracapsular cataract extraction (ECCE) is an older technique used for very dense or advanced cataracts. It involves making a larger incision (8-10 mm) to remove the cataract in one piece while preserving the back capsule of the lens. An IOL is then implanted, and the incision is closed with sutures.

• Benefits: ECCE is effective for cases where phacoemulsification is not feasible due to the cataract’s density.
• Suitability: Rarely used in Singapore today, this method is reserved for complex cases or when advanced equipment is unavailable.
• Considerations: This procedure requires a longer recovery time due to the larger incision and sutures, which may need removal 1-2 months post-surgery.

Understanding Intraocular Lens (IOL) Options

After the cataract is removed, an artificial intraocular lens (IOL) is implanted to restore vision. IOLs are made of biocompatible materials like acrylic or silicone and are designed to remain permanently in the eye without maintenance. The choice of IOL significantly impacts post-surgery vision quality.

Here are the main types available in Singapore:

1. Monofocal Lens

Monofocal lenses provide clear vision at one distance, typically for distance vision (e.g., driving or watching TV). Patients may need glasses for near tasks like reading or using a smartphone.

• Benefits: Cost-effective, widely covered by insurance, and free from visual disturbances like halos or glare.
• Considerations: The primary limitation is its single focal point, which means additional corrective lenses are needed for other distances.

2. Multifocal Lens

Multifocal lenses are designed to provide clear vision at multiple distances—near, intermediate, and far—reducing the need for glasses. They are ideal for patients who prioritise spectacle independence and have healthy eyes without significant astigmatism.

• Benefits: Greater independence from glasses for activities like reading, computer work, and driving.
• Considerations: Some patients may experience halos or glare, particularly at night, which can affect driving.

3. Trifocal Lens

Trifocal lenses are an advanced type of multifocal lenses that provide clear vision at three specific distances: near (for reading), intermediate (for computer work), and far (for driving).

• Benefits: Broader range of clear vision, ideal for patients seeking minimal reliance on glasses across various activities.
• Considerations: More expensive and may cause minor visual disturbances like halos or glare, although less pronounced than older multifocal lenses.

4. Extended Depth of Focus (EDoF) Intraocular Lenses

EDoF lenses provide a continuous range of vision from near to far, offering a balance between multifocal lenses and monofocal lenses. This makes them an ideal option for patients who want versatile vision correction with minimal visual disturbances.

• Benefits: Good clarity across distances with fewer visual side effects like halos or glare compared to multifocal lenses.
• Considerations: Near vision may not be as sharp as trifocal lenses for very close-up tasks.

Choosing the Right Surgery for Your Eyes

There is no universally “best” cataract surgery or IOL; the optimal choice depends on several individual factors:

1. Eye Structure

The shape and health of your eye, including the cornea and lens capsule, influence which surgical technique and IOL are most suitable. For example, patients with thin corneas may benefit from LACS for its precision.

2. Vision Needs

Your lifestyle and visual requirements play a significant role. If you want to reduce dependence on glasses for reading or computer work, multifocal, trifocal, or EDoF lenses may be preferable. Conversely, if you are comfortable with glasses for certain tasks, a monofocal lens might suffice.

3. Existing Eye Conditions

Conditions like astigmatism, glaucoma, or macular degeneration may require specific surgical approaches or IOL types, such as toric lenses for astigmatism. An eye specialist will assess these conditions during a comprehensive eye examination.

Remember, the key to a successful outcome is a personalised approach. Working with an ophthalmologist allows you to create a customised treatment plan, guided by a thorough pre-operative assessment of your eye's dimensions and health. This process ensures your procedure is perfectly tailored to your unique needs.

For personalised advice and a comprehensive assessment, contact our cataract surgery clinic in Singapore today at 6737 8366.