Dr Anita Sethi

Premium Lens Selection: If you are choosing multifocal, trifocal, or toric IOLs, where perfect lens centration is critical for optimal vision.

Pre-existing Astigmatism: When you wish to correct corneal astigmatism during the same procedure to reduce dependence on glasses.

Vulnerable Corneas: For patients with conditions like Fuchs' dystrophy, where reducing surgical energy is vital to protecting the cornea.

Advanced Cataracts: When the lens is particularly dense, the laser can pre-soften the cataract, making removal safer.

Desire for Precision: When seeking the highest level of computer-guided accuracy to minimize manual variability.

Imaging & Mapping: The surgeon uses Optical Coherence Tomography (OCT) to create a detailed 3D map of the eye's unique internal anatomy.

Corneal Incisions: Based on the 3D map, the laser creates ultra-precise, self-sealing incisions for surgical entry.

Capsulotomy: The laser creates a perfectly circular opening in the thin membrane (capsule) that holds the lens.

Lens Fragmentation: The laser vibrates at high speeds to soften and break the cataract into tiny pieces before any tools enter the eye.

Lens Removal: The pre-softened fragments are gently suctioned out using an ultrasonic probe with significantly reduced energy.

IOL Implantation: A permanent artificial intraocular lens (IOL) is inserted to restore clear focus.

Duration: The entire outpatient process typically takes between 15 and 30 minutes per eye.

Detailed Biometry: Advanced laser measurements of the eye's length and curvature to select the most appropriate IOL.

3D Surgical Planning: Using the OCT data to program the laser for the exact depth and location of all incisions.

Medication Audit: Starting antibiotic or anti-inflammatory eye drops a few days before the procedure as prescribed.

Fasting: Following clinical instructions regarding food and water intake on the morning of the surgery.

Logistics: Arranging for a companion to assist with the return home, as vision may be temporarily blurry.

Optical Coherence Tomography (OCT): To visualize the different layers of the eye and ensure the macula is healthy.

Topography: Mapping the surface of the cornea to plan for astigmatism correction.

Endothelial Cell Count: Checking the health of the inner corneal layer, especially for patients with pre-existing corneal issues.

Visual Field Testing: To confirm that the cataract is the primary cause of vision loss and rule out other underlying conditions.

Initial Vision: Many patients report clearer vision within 24 to 48 hours due to reduced intraoperative inflammation.

Medication: Strict adherence to antibiotic and anti-inflammatory eye drops for several weeks is necessary for healing.

Eye Protection: Wearing a protective shield while sleeping for the first week to prevent accidental pressure or rubbing.

Activity Restrictions: Patients should avoid heavy lifting, bending over, or getting water/dust in the eye for the first 2–3 weeks.

Long-Term Healing: While initial improvement is rapid, full stabilization of the eye typically takes 4 to 6 weeks.

Enhanced Precision: Laser-guided steps are accurate to within a hundredth of a millimeter, significantly reducing manual variability.

Reduced Stress on the Eye: Because the laser pre-softens the lens, much less ultrasound energy is required, leading to faster corneal recovery.

Perfect Centration: The automated capsulotomy ensures the artificial lens is perfectly centered, which is vital for the performance of premium lenses.

Customized Correction: The laser can reshape the cornea to treat minor astigmatism with a level of accuracy difficult to achieve by hand.

Consistent Outcomes: The integration of real-time 3D imaging allows for a highly predictable and standardized surgical experience.

Nearsightedness (Myopia): When nearby objects are clear, but distant objects appear blurry.

Farsightedness (Hyperopia): When you can see distant objects clearly, but close-up tasks cause eye strain or blur.

Astigmatism: When the cornea is shaped more like a football than a basketball, causing overall distorted vision.

Dependence on Corrective Lenses: When you wish to eliminate or significantly reduce the need for glasses or contact lenses for daily activities.

Stable Vision: When your eye prescription has remained unchanged for at least one to two years.

Step 1: Numbing: Anesthetic eye drops are applied so you remain awake and comfortable throughout the procedure.

Step 2: Flap Creation: A thin, hinged flap is created on the outer layer of the cornea and folded back to access the underlying tissue.
Traditional LASIK: Uses a mechanical handheld blade called a microkeratome.
Femto-LASIK: Uses a high-precision femtosecond laser to create the flap, making it "bladeless."

Step 3: Reshaping: An excimer laser is used to remove microscopic amounts of tissue from the inner cornea to improve how light focuses on the retina.

Step 4: Repositioning: The corneal flap is folded back into its original position, where it bonds naturally and begins healing immediately without the need for stitches.

Duration: The entire outpatient process typically takes about 10 to 20 minutes for both eyes.

Contact Lens Holiday: You must stop wearing contact lenses (usually 1–3 weeks before) to allow the cornea to return to its natural shape.

Corneal Mapping: Detailed 3D scans are taken of the eye's surface to program the laser for your specific correction needs.

Medication Audit: Discussing any history of dry eyes or autoimmune conditions with your surgeon that might affect healing.

Transportation: Arranging for a ride home after the procedure, as your vision will be foggy and you may experience light sensitivity.

Corneal Topography: A specialized map that measures the curvature and thickness of the cornea to ensure it is healthy enough for surgery.

Pachymetry: Measuring corneal thickness; Femto-LASIK is often preferred for patients with thinner corneas.

Dry Eye Assessment: Checking tear production to determine if post-operative dryness needs to be managed proactively.

Wavefront Analysis: A highly detailed "fingerprint" of your vision that detects subtle imperfections to guide a customized laser treatment.

Initial Vision: Most patients see clearly within 24 to 48 hours, though vision may fluctuate slightly for the first few days.

Post-Op Symptoms: Temporary grittiness, dryness, or light sensitivity is normal immediately following the surgery.

Prescribed Drops: You must strictly follow the schedule for antibiotic and anti-inflammatory eye drops to prevent infection.

Eye Protection: Wearing protective sunglasses or shields is recommended, especially while sleeping, to prevent accidental rubbing.

Activity Restrictions: For the first week, avoid wearing eye makeup, swimming, or participating in contact sports.

Higher Precision: Femto-LASIK allows for customizable flap dimensions, ensuring a safer and more predictable surgical outcome.

Expanded Eligibility: Bladeless technology makes refractive surgery an option for patients who were previously told their corneas were too thin for a blade.

Reduced Complications: The use of a computer-guided laser minimizes risks such as irregular flap creation or flap dislocation.

Rapid Results: Most patients return to work and light daily activities within 24 hours of the procedure.

Permanent Vision Correction: By physically reshaping the cornea, the procedure provides a long-term solution for refractive errors.

Congenital Cataracts: When a baby is born with a clouded lens that blocks light from reaching the retina.

Developmental Cataracts: If a cataract develops during early childhood, affecting school performance or physical coordination.

Leukocoria (White Pupil): When a white reflection is noticed in the child’s pupil in photos or under bright light.

Nystagmus: If the child's eyes begin to shake or wander because they cannot focus on objects clearly.

Strabismus (Squint): When an eye begins to turn inward or outward because the cataract is preventing the eyes from working together.

Anesthesia: The surgery is performed under general anesthesia to ensure the child remains perfectly still and comfortable.

Incision: A microscopic incision is made in the cornea or the white part of the eye (sclera).

Lensectomy: Because a child’s lens is naturally soft, it is usually aspirated (gently suctioned out) rather than broken up with ultrasound energy.

Primary Posterior Capsulotomy (PPC): In children (especially under age 5), the back part of the lens capsule is intentionally opened to prevent a "secondary cataract" from forming.

Anterior Vitrectomy: A small amount of the vitreous gel is removed from the front of the eye to keep the visual axis clear for light to pass through.

IOL Implantation: * Children (over 1–2 years): An artificial Intraocular Lens (IOL) is usually implanted.
Infants: Surgeons may leave the eye "aphakic" (no lens) and use specialized contact lenses or glasses until the eye grows larger.

Suturing: Unlike adult surgery, the incisions must be stitched with absorbable sutures to ensure the wound is strong enough for an active child.

Duration: The procedure typically takes between 45 and 90 minutes.

Pediatric Assessment: A comprehensive eye exam, often done under light sedation for younger children, to measure the eye's length and curvature.

IOL Calculation: Using specialized formulas to predict how the eye will grow and what lens power will be needed for the future.

Fasting: Following strict "nothing by mouth" instructions for the hours leading up to general anesthesia.

Amblyopia Plan: Discussing the likelihood of needing Patching Therapy after surgery to treat "lazy eye."

Logistics: Preparing for a day-care hospital stay and ensuring the child is healthy (no coughs or colds) on the day of surgery.

A-Scan Biometry: To measure the length of the eye and calculate the appropriate lens power.

B-Scan Ultrasound: To ensure the retina is healthy and attached behind the clouded lens.

Red Reflex Test: A simple but vital check to see how much light is actually being blocked by the cataract.

Retinoscopy: To assess the refractive error and prepare for the high-power glasses or contacts needed post-op.

Intensive Medication: Antibiotic and steroid eye drops are required for 4 to 8 weeks to manage the child's strong immune response.

Eye Protection: The child must wear a protective shield or specialized "arm restraints" (for infants) to prevent them from rubbing or poking the eye.

Vision Correction: Almost all children will need high-power glasses or contact lenses immediately to help the brain learn to see.

Patching Therapy: The "good" eye may be covered for several hours a day to force the brain to use the eye that had surgery.

Long-Term Monitoring: Frequent check-ups are required to watch for Glaucoma or "Visual Axis Opacification" (where the capsule tries to grow back shut).

Prevents Permanent Blindness: Removing the cataract early allows light to stimulate the brain during the critical period of visual development.

Reduces Secondary Cataracts: Techniques like PPC and vitrectomy significantly lower the risk of the vision clouding over again.

Customized for Growth: The surgical approach is tailored to the child's age, whether they need an immediate IOL or temporary contact lenses.

Stronger Wound Closure: The use of absorbable sutures provides the necessary structural integrity for a child's active lifestyle.

Comprehensive Care: Combines surgery with orthoptic therapy (patching) to ensure the highest possible quality of long-term vision.

Mature or "Hard" Cataracts: When the cataract is very dense (black or brown) and may be difficult to break apart using ultrasound energy.

Cost-Effective Treatment: When seeking a high-quality surgical outcome at a lower price point compared to laser or ultrasonic methods.

Limited Infrastructure: Ideal for settings where consistent electricity or expensive high-tech maintenance is unavailable.

Complex Eye Conditions: Useful for patients with small pupils, weak fibers holding the lens (zonules), or a history of eye trauma.

Advanced Vision Loss: When the cataract has progressed to the point of "white" or "hypermature" stages, making other techniques riskier.

Preparation: The eye is numbed using local or peribulbar anesthesia and sterilized with povidone-iodine.

Sclerocorneal Tunnel Construction: The surgeon creates a 5.5 mm to 7 mm triplanar tunnel in the sclera (the white of the eye) that extends into the cornea.

Capsulotomy: An opening is made in the lens capsule—the "bag" holding the lens—to access the cataract.

Hydrodissection: Fluid is injected to gently loosen the lens from its surrounding capsule.

Nucleus Delivery: The hard central part of the lens (nucleus) is manually expressed through the tunnel using specialized tools like an irrigating vectis or via hydrostatic pressure.

IOL Implantation: A permanent artificial intraocular lens (IOL) is inserted into the capsule to restore clear focus.

Closure: The tunnel's specific internal shape makes it self-sealing, meaning it stays closed due to natural eye pressure and usually does not require stitches.

Biometry: Precise measurements of the eye's length and corneal curvature to determine the correct power for the artificial lens.

Infection Screen: Ensuring the eyelids and surrounding skin are free of infection or inflammation before the incision.

Medication Audit: Discussing current medications with the surgeon, particularly blood thinners or prostate medications that can affect the iris.

Fasting: Following clinical instructions regarding food and water intake on the day of the procedure.

Visual Acuity: Measuring the baseline level of vision impairment caused by the cataract.

Slit-Lamp Exam: A microscopic evaluation of the cataract's density and the health of the cornea and iris.

Intraocular Pressure (IOP): Checking the pressure inside the eye to ensure it is within a safe range for surgery.

B-Scan Ultrasound: Performed if the cataract is so dense that the surgeon cannot see the back of the eye, to ensure the retina is healthy.

Initial Vision: Vision often improves within 24 to 48 hours, though full stabilization and final healing typically take 4 to 6 weeks.

Medications: Patients must strictly use prescribed antibiotic and anti-inflammatory eye drops for several weeks.

Eye Protection: Wearing a protective shield or glasses to prevent accidental rubbing, especially while sleeping.

Activity Restrictions: Avoid heavy lifting, bending over, or getting water, soap, or dust in the eye for the first 1–2 weeks.

Follow-up: Attending scheduled appointments to monitor the healing of the self-sealing tunnel and check for any inflammation.

Superior for Dense Cataracts: Allows for the safe removal of very hard lenses that might cause complications with other methods.

Rapid Visual Recovery: Provides a quick return to functional vision, which is essential for patients in high-volume settings.

Durability: The self-sealing tunnel is structurally strong and resistant to accidental trauma during the healing phase.

Accessibility: Eliminates the need for phacoemulsification machines, making life-changing surgery available in rural and remote areas.

Excellent Outcomes: When performed by skilled surgeons, the visual results and safety profile are excellent and long-lasting.