We do not offer femtosecond laser cataract surgery to our patients at Burlington County Eye Physicians. While combining traditional phacoemulsification (technical term for modern cataract surgery) with the precision of the femtosecond laser sounds intriguing, no scientific studies have demonstrated any significant benefit to the patients.
In fact, using the femtosecond laser could increase the chance of certain complications from arising.
There are 3 steps in cataract surgery where use of the laser has been predicted to improve outcomes;
- Corneal Incision – this creates entry into the eye
- Capsulorhexis – a circular hole in the front face of the cataract
- Cataract removal – pretreats cataract and allows easier removal
The Corneal Incision
The corneal incision is the first step to cataract surgery. The incision is the first surgical cut into the eye and gives the surgeon an entryway inside the eye. Ideally, this “cut” should heal without changing the shape or curvature of the cornea.
Irregular curvature of the cornea is called astigmatism and may produce unexpected visual results after cataract surgery.
Corneal incisions are typically created manually by the cataract surgeon using a micro-surgical blade or diamond knife.
In contrast, in laser cataract surgery, the laser creates this entry wound. No study has demonstrated any benefit by having the laser perform the initial corneal incision.
The natural lens of the eye is very similar to an M&M piece of candy. The actual lens has an outside “capsule” that is analogous to the outside candy coating of the M&M.
Once inside the eye, a hole is created in the capsule, or candy coating, allowing to the surgeon to remove the inner contents of the cataract; in our analogy, this would be the chocolate.
This initial hole is called the capsulorhexis. Both the size and shape of the capsulorhexis is critical to the success of the operation and the stability of the intraocular lens.
The ideal capsulorhexis is uniformly round and large enough to allow access to remove the inner lens material.
Typical cataract surgery involves the use of microforceps to create the capsulorhexis.
The femtosecond laser can reliably create the capsulorhexis, however tears in the capsulorhexis can develop at a higher rate with the laser, which can lead to instability of the lens implant.
Removal of the Lens Material
Typical cataract surgery use ultrasound energy to liquefy the cataract. This process is called phacoemulsification.
Laser cataract surgery still requires phacoemulsification; however, the use of the laser to pretreat the cataract may reduce the amount of ultrasound energy required to complete the cataract removal.
Too much ultrasound energy can prolong healing and potentially damage the cornea.
Shortcomings and Concerns of Laser Cataract Surgery
There is no data to support the speculation that visual outcomes are better with laser cataract surgery compared to manual phacoemulsification.
There is no evidence that there is less astigmatism with use of the laser compared to traditional cataract surgery, nor are there differences in the stability of the IOL.
The creation of the capsulorhexis may be accomplished by the laser, but has not been shown to be any better than the manually created version.
Removal of the lens material in most cases is safely achieved using modern ultrasound techniques and damage to the cornea is not a concern.
Femtosecond cataract surgery is not covered by medical insurance plans, so the patient may experience significant out-of-pocket costs, sometimes thousands of dollars, with no benefit to their visual outcome.
Finally, integrating the femtosecond will also add time to the procedure. At the very least, a longer procedure increases the costs of anesthesia and increases the chances of complications (the more steps to a procedure, the more chance of problems).
We look forward to seeing you. Please call us (609.877.2800) for an appointment.