Ophthalmologist Op. Dr. Sinan Göker gives information about “smart lenses” applied in cataract and age-related nearsightedness:
I would like to start our conversation with smart lenses. Why are they called “smart lenses”? What are the features of these lenses?
"The lenses that are put into the eye during cataract surgery, intraocular lenses, are called smart lenses. These were single-focused when they first came out. The person's own lens, which was hazy, was removed and replaced with a transparent, synthetic single-focal lens. By adjusting the numbers with single-focal lenses, people were using reading glasses for near while the distance number was corrected. Later, multifocal intraocular lenses were designed to eliminate these near reading glasses. These were later called “smart lenses” because they also allow the person to see near. Therefore, single-focal lenses have fallen into the position of mindless lenses. Then, of course, they continued to develop within themselves."
HOW CAN YOU GET RID OF READING GLASSES WITH SMART LENSES?
“Today, smart lenses are also used to save people with age-related near vision problems from glasses, right?”
"Yes, but they had some side effects when they first came out. The smart lenses that I have been using in Turkey for 20 years have evolved over time to such a good position that patient satisfaction has increased. Therefore, apart from cataract surgery, that is, people who do not have cataracts but who have started to have age-related near problems started to demand it and we started to do it. The near problem starts after the age of 45. Therefore, it is now possible to routinely wear these multifocal eyepieces, smart lenses, to anyone over the age of 45 who wants to get rid of near glasses."
SMART LENS SURGERY TAKES 10 MINUTES
So how are such operations done, what is the anesthesia like? How long does it take? For example, how much time should a person who comes to Turkey from Greece and thinks ‘Let me have a vacation and have my age-related nearsightedness treated with these smart lenses’ allocate?
"Now, this is actually a cataract surgery performed with the method we call FAKO. It is the gold standard. I have been practicing FAKO in Turkey for about 35 years. One eye takes about 10 minutes. My surgery is actually 6-7 minutes. I prefer not to do both eyes on the same day. It can be done, but it is not right, firstly in terms of risk. Secondly, it is more ideal to do it two days apart in order to get a better result, that is, a result closer to zero. Therefore, when the patient comes to us, we do the examination in the morning on the same day. Then we operate on one eye on the same day. The next day we check that eye. The patient rests. We operate on the second eye the next day, the third day. Thus, on the third day of arrival, the second eye is also done. We check that eye on the fourth day. And then the patient can return. In other words, two eyes are finished in a total of four days. The next day after cataract surgery, the patient can get on a plane, bus or travel."
And can he drive a car?
"It will take one more day before he can drive a car. So we can say the 5th day."
TREATMENTS THAT SAVE FROM NEAR AND FAR GLASSES
You just said that it takes about 10 minutes to put a smart lens in one eye. Do you need to be hospitalized after this surgery? Or can patients travel around Istanbul and its surroundings?
"Let me explain the surgery a little bit. The surgery is an easy surgery. We anesthetize with a drip. We give sedatives and tranquilizers intravenously. Therefore, patients do not even realize that they are undergoing surgery. It is over in 10 minutes. We cover that eye with tape. He goes home or to a hotel and rests. Because he needs to rest the same day. The next day he comes to us at the clinic. We open his eye and he starts to see in one eye. Far, near numbers are zero, and the cataract is gone. The next day, the person can return to normal daily life. In other words, he can go out on the street, take a small tour of Istanbul. On the third day we do the other eye. That day, he rests at home or in a hotel. He does not go out. Fourth day control. We open the second eye and he can go back to his normal daily life. Now he can travel, he can visit Istanbul if he wants. But a month is needed for a sea vacation. After cataract surgery, smart lens surgery, we do not want to go to the sea or pool for a month. Maybe three weeks."
NO MORE NEAR OR FAR GLASSES WITH SMART LENSES!
I would like to learn the following. You said that even if people do not have cataracts, they prefer to have surgery to get rid of the glasses or contact lenses they use due to age-related nearsightedness. So, what kind of differences and changes are observed in people's quality of life after smart lenses?
"Now, the age of cataract has already come too early. Today, it is frequently seen in people in their 50s, but it has also started to be seen among younger people, that is, in their 40s. After the age of 45, the near problem already starts. Therefore, while a cataract surgery will be necessary in 4-5 years, there is no harm in moving it 4-5 years earlier. There is no benefit in waiting for cataract anyway. Therefore, with a 10 minute surgery, the cataract is removed and the person is prevented from having cataract surgery in the future. Moreover, the need for glasses is eliminated with multifocal intraocular lenses that correct the far, near and now also the middle distance. These are trifocal lenses. Considering that the close reading distance is 30-40 centimeters and the middle distance is 80 centimeters, it is now possible to see far and near without glasses. Let's imagine that a person uses a smartphone for 4-5 hours a day. He uses near glasses while looking at the smartphone. When he looks far away, he needs to take off those glasses. Put the glasses on and take them off. Apart from that, if he is doing a desk job, working in an office or doing something with a computer, he looks at that computer for 8 hours. The computer distance enters the center. Then, when he looks closer, he needs close-up glasses again. So one pair of glasses is not enough. He needs two close glasses. So this is a situation that makes life very poor quality. That's why they want to increase their quality of life by bringing an operation they will have in the future to an earlier age. They want to experience that comfort earlier. The number of patients we have implanted with smart lenses has far exceeded those we have operated on for cataracts. In other words, people started to have this surgery to get rid of their near glasses."
WHICH COUNTRIES DO PATIENTS COME FROM THE MOST FOR EYE TREATMENTS?
For eye surgeries, many patients come to Istanbul from abroad as well as from outside the city. Both for laser treatments and for the surgeries you mentioned with intraocular lenses. So, from which countries do most patients come to Turkey?
"Patients come to Turkey mostly from countries where the states do not cover the operations performed with smart lenses. Germany is one of them. Countries like the Netherlands and England. Generally, in these countries, insurances cover single-focal lenses. Because multifocal lenses are a luxury. Therefore, they do not perform them in public hospitals. They also wait for the cataract to progress well to perform cataract surgery. They tell patients to come after the cataract progresses. However, people want to improve their quality of life at an earlier age. Therefore, patients who cannot benefit from state facilities and who will go to the private sector are more likely to apply from abroad."
DOCTOR'S EXPERIENCE IS IMPORTANT IN SMART LENS SURGERIES!
So now let's consider a patient living abroad, in Greece. Why should he prefer Turkey? How is the technology? How is the experience of the physicians here?
"Now, this multifocal intraocular lens technology has been practiced in the world for about 23 years. I have been practicing in Turkey for 20 years. Now, in fact, maybe 20 percent of doctors in Turkey and Europe use these trifocal lenses, multifocal lenses. Because these are really very special surgeries, they need to be done very well. The slightest problem can cause discomfort in the person. Therefore, the best lens should be used. Understanding which is the best lens requires experience. Because every company praises itself by saying “We have the best lens”, but the doctor who uses it best, especially the one who has done many cases, knows it best. I have worn nearly 10 thousand multifocal intraocular lenses until today. 20 years is a very long time. Therefore, for example, the number should be exactly zero in these lenses. Even 0.75 distorts vision very much. Then the patients say, ‘I had surgery, why do I still see blurred?’ If such a thing happens in my cases, I reduce that remaining number to zero with laser after 4-5 months. In other words, I leave my patient exactly zero. This makes a big difference."
WHO ARE THE MOST SUITABLE PATIENTS FOR SMART LENS SURGERY?
Do these lenses have some side effects, such as light refractions while driving at night on a long road? Can they be worn by everyone? Is there a patient group you do not recommend?
"First of all, the condition of the retina is important. The retina inside the eye must be intact. Therefore, we do not fit smart lenses to retina patients. In other words, we do not wear them in the disease we call age-related retinal macular degeneration. Apart from that, these lenses can slightly distort the headlights of the oncoming car while driving at night in half of the patients. The person can see rings. But it is not so bad that you cannot drive. And if it happens, this situation decreases very much between 6-9 months. I can say it almost passes. It is temporary, but you use the right lens. Therefore, if a person's profession is driving at night and this happens to that person, even if it is temporary, it may cause discomfort. Therefore, we clarify this situation by discussing it with the person and talking about it thoroughly. We may not wear them for people who drive at night and whose profession is driving."
YOU CAN GET RID OF BOTH CATARACTS AND GLASSES WITH SMART LENS SURGERY!
Can smart lenses be applied to every patient who needs cataract surgery? Or how do you decide which lens to fit to which patient?
"Now, since I have been practicing this treatment for 20 years and I am an expert on the subject, all of the patients who come to me already apply for smart lens treatment. Therefore, I wear smart lenses to almost all of my patients. As I said before, I only wear single-focal lenses to people who have problems in the retina. I can say that these are in a group of maybe five percent of the patients who apply to me. Everyone else can be fitted with smart lenses."
Again, let's consider a patient from Greece. When he first applies to your clinic, he undergoes a detailed eye examination, right? How long do these procedures take?
"Of course, we go through a very, very detailed examination. Because according to the results we find in that examination, it is determined which lens and how many numbers we will put into the eye. This examination takes approximately 2-3 hours. So the surgery is 10 minutes but the examination is three hours. When we do this surgery, we reset the numbers. Far, near, middle becomes zero. And the numbers do not deteriorate again until the end of the person's life. Also, since cataract surgery is performed, cataracts do not occur again. It is a once-in-a-lifetime surgery."
FIRST DETAILED EYE EXAMINATION, THEN SURGERY
When I listen to you, I understand that after a detailed examination lasting about 3 hours, you decide what kind of treatment will be applied to a patient, what kind of lenses will be worn.
"Absolutely. It is so special that even a person's right eye and left eye can be different from each other."
YOU CAN GET RID OF BOTH CATARACTS AND GLASSES WITH SMART LENS SURGERY!
I have one last question. Suppose a person has had cataract surgery in the past. Health technologies are developing. If this person asks you, “Can I be treated with smart lenses?” Is there such a possibility?
"Yes. In other words, he had cataract surgery before and a single-focal lens was implanted in his eye. In other words, a person with a mindless lens cannot see near. We can put a smart lens on the old lens with a second surgery. So there are two lenses inside the eye. One for distance and one for near. And the results are very good. It is like a new technology. I have been wearing it for about 2-3 years and we get very good results. Patients are very satisfied."