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Laser Cataract Surgery with Femtosecond Technology

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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.

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:

  1. 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.
  2. 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.
  3. 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, currently this step has not changed, but may change in the future.
  4. 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

Surgeons who are involved in laser cataract surgery say the new procedure improves 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.

Eye surgeons also feel that using a femtosecond laser to create the clear corneal incision in cataract surgery produces a tighter-closing wound, reducing the risk for eye infection after surgery.

Though laser-assisted cataract surgery increases the cataract surgery cost in some practices, the new procedure may eventually enable surgeons to perform more surgeries per day, offseting some of the added costs. (See information below related to cost.)

Current Status of Laser Cataract Surgery

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.

As of April 2013, approximately 125,000 laser cataract surgery procedures had been performed worldwide in more than 30 countries, most of which were in the United States.

Four types of femtosecond lasers have been approved by the FDA for use in the US.

LenSx - manufactured and distributed by Alcon Corp (TX, USA).

Optimedia Catalys – manufactured and distributed by Optimedica Corp (CA, USA)

LensAR – manufactured and distributed by LensAR Inc, (FL, USA)

Victus – manufactured by Technolas (Munich, Germany) and distributed by Bausch and Lomb Surgical (CA, USA)

Cost of Laser Cataract Surgery

The cost of laser cataract surgery varies from practice to practice. Practices in certain parts of the United States are including the use of the femtosecond laser in the cataract surgery procedure at no charge. This pricing trend is expected to be discontinued as more practices adopt the new technology.

According to participants at the Ophthalmology Innovators Summit, the average increase in cost for laser cataract surgery is $ 872 per eye.

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.

Note: This information is for general education purposes only. It is not to be used as a substitute for medical advice from your eye doctor or refractive surgeon.

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