Laser Cataract Surgery with Femtosecond Technology
Cataract surgery is one of the most frequently performed surgeries in the world today, enabling millions of people to regain eyesight lost because of cataracts.
Modern cataract surgery is safe, effective and highly predictable. And surgical tools and techniques are constantly evolving to make the procedure even better.
The next major advance in cataract surgery may be the use of femtosecond lasers — like those used in all-laser LASIK — to perform some of the steps in the cataract procedure.
PRK offers results that are similar to those achieved by LASIK, but it involves more post-operative discomfort and longer healing times. PRK is often recommended for patients whose corneas are too thin for LASIK.
The Laser Cataract Surgery Procedure
Using a laser for certain steps in cataract surgery has the potential to increase accuracy of the surgical procedure, decrease surgical time, decrease cataract surgery recovery time and improve visual results.
Basically, here are the four steps of modern cataract surgery and how these steps may be modified in laser cataract surgery:
- Creating corneal incisions. The first step of cataract surgery is to create an incision, usually in the periphery of the cornea, to enable the cataract surgeon to gain access to the cloudy lens inside the eye. Typically, these incisions are made with a hand-held surgical blade. In laser cataract surgery, they are created with a laser.
- Performing an anterior capsulotomy. The lens inside the eye is contained within a clear thin sack called the lens capsule. To break up and remove a lens clouded by a cataract, the surgeon must create an opening in the front part of the capsule (anterior capsulotomy). Typically, an anterior capsulotomy is performed with a hand-held cutting tool. In laser cataract surgery, this step is performed with a laser.
- Lens fragmentation. Prior to removal of a cataract, the cataract surgeon breaks the cloudy lens into smaller pieces, so it can be removed through the very small corneal incision. Typically, this is done with an ultrasonic probe. In laser cataract surgery, this step is performed with a laser.
- IOL implantation. After the cataract has been broken up and removed, the eye's natural lens is replaced with an intraocular lens (IOL), such as a multifocal IOL or an accommodating IOL to correct presbyopia. This step is not changed by laser cataract surgery.
And, if the patient has astigmatism, then an additional step may be incorporated into the cataract surgery procedure.
Creating limbal relaxing incisions (LRI). This step involves making a precise, partial-thickness radial incision in the peripheral cornea to alter the shape of the front of the eye and thereby correct astigmatism. Typically, a LRI is created with a hand-held, bladed tool (much like how RK was performed). In laser cataract surgery, this step may soon be performed with a laser.
Benefits of Laser Cataract Surgery
Researchers and surgeons who are involved in the development of laser cataract surgery say the new procedure will improve the reliability, reproducibility and safety of cataract surgery.
Refractive and visual outcomes also may be improved, resulting in true refractive cataract surgery that greatly reduces or eliminates the need for eyeglasses after surgery.
Researchers also say that using a femtosecond laser to create the clear corneal incision in cataract surgery will produce a tighter-closing wound, reducing the risk for eye infection after surgery.
Though laser-assisted cataract surgery will likely increase cataract surgery cost, the new procedure may enable surgeons to perform more surgeries per day, which may offset some of the added costs, say some proponents.
Current Status of Laser Cataract Surgery in the U.S.
Currently, at least four companies are developing lasers to make laser cataract surgery a reality in the United States.
These companies are: Abbott Medical Optics (Santa Ana, Calif.), LensAR (Winter Park, Fla.), LenSx Lasers (Aliso Viejo, Calif.) and Optimedica (Santa Clara, Calif.).
On March 9, 2010, LenSx Lasers announced Stephen G. Slade, MD, (Houston, Texas) performed the first laser cataract surgery in the United States, using the FDA-approved LenSx femtosecond laser.
"I have been involved in many new technology introductions, and I know from these past experiences that bladeless laser cataract surgery will be widely accepted by surgeons and demanded by patients all over the world," said Dr. Slade after the procedure.
In May 2010, LensAR announced their femtosecond laser system for performing anterior capsulotomy during cataract surgery received FDA approval.
The LensAR Laser System "integrates propriety ocular measurement and 3D laser scanning technologies with an advanced tissue cutting laser," according to the company.
More About Laser Cataract Surgery
The technology used in laser cataract surgery is changing rapidly.
If you are interested in this new procedure, consult with an experienced cataract surgeon to determine if laser cataract surgery is right for you and if it is available in your area.
Last updated: August 25, 2010
