Laser or Femtolaser cataract surgery is currently the most advanced way to remove a cataract. It offers increased safety, precision, and makes cataract surgery less traumatic to the eye. There are 4 main advantages for laser cataract surgery in : 1. increased reproducibility of the capsulotomy, 2. softening of hard cataracts leading to decreased ultrasound energy and less trauma to the eye, 3. increased precision of location and architecture of the incision, and 4. ability to correct minor astigmatism to improve vision without glasses. Each step will be discussed below.
The most important step of cataract surgery is the capsulotomy. The lens is encapsulated by a very thin and delicate membrane called the capsule. Before laser cataract surgery was available, the capsule had to be opened manually by the surgeon. This is usually done with a bent needle to puncture the capsule and create a flap. Micro-forceps are then used to pick up the flap and tear a circular opening in the capsule right under the pupil. This delicate procedure is similar to peeling the skin of a grape. If this step is not done correctly, the integrity of the capsule can become compromised making it much more difficult to remove the cataract. Complications such as vitreous prolapse (when the gel behind the eye comes forward causing inflammation, glaucoma, and retinal detachment) and retained lens material (when lens material falls back because the capsule is compromised) can occur when the capsule is broken.
The laser is image-guided by a scanner called an OCT that precisely maps the structure of the eye in 3 dimensions. This image guided laser then cuts a perfectly circular opening in the capsule exactly 5.0 mm. The precision and reproducibility of the laser is unmatched even by the best surgeons. The size and location of the capsulotomy is critical for the accuracy of the lens implant. The greater the accuracy, the higher the chance that the patient will achieve spectacle-free vision.
The cataract is basically a clouding of the natural lens with age. As this occurs, cataracts harden. Traditionally, cataract are removed using sound waves to break the lens into smaller pieces. The denser and harder the cataract, the more ultrasound energy required. This increase in energy can cause irreversible damage to the cells that line the back surface of the cornea called endothelial cells, leading to swelling and clouding of the cornea which can take time to clear. If too much damage occurs to these cells, the cornea may not recover and a corneal transplant may be required. The second major advantage of femtolaser cataract surgery is that the laser pre-softens the lens making cuts in a grid pattern in the lens. With the lens pre-softened, less ultrasound is required making the surgery less traumatic and resulting in clearer corneas and more rapid visual recovery.
The third advantage is that the image guided laser can also create very precise incisions. In the traditional way, a metal scalpel blade is used to create the incisions. This creates more variability in both the location and architecture of the incision. With the femtolaser the exact location in degrees is specified along with the exact length, width, and architecture of the incision. This increase in precision is especially helpful when one is also planning to reduce astigmatism.
The final advantage of laser cataract surgery is that we can use is to create relaxing incisions in the peripheral cornea to correct minor astigmatism (up to 1.0-1.25 diopters). Before the advent of the laser, this was usually done manually with a diamond blade. However, as with the capsulotomy and incisions, we can now do this more accurately with an image-guided laser. The location, size, and depth of these incisions can be accurately made by the OCT guided laser to optimize the effectiveness of the astigmatism correction.
In summary, there are multiple advantages to femtolaser cataract surgery. It is the best and safest way to perform cataract surgery today. I also recommend it to all my patients except when the pupil is too small, the cornea is not clear, or the extra expense is an issue. In our practice we offer 0% interest financing with Care Credit to make it more affordable to all our patients. Make an appointment at one of our locations to discuss the possibilities of femtolaser cataract surgery along with our premium lenses.