Cataract surgery is one of the most common and safest surgical procedures performed through out our country and through out the world for that matter. A cataract occurs when the natural lens with in one’s eye becomes clouded. This is a natural process which most individuals experience as time goes on. As the cataract grows cloudier, it causes a deterioration of vision. As this decrease in vision starts to decrease the quality of life or ability to function normally for the individual, cataract surgery may be indicated.
Cataract surgery is when the cloudy natural lens is surgically removed and replaced with an intraocular lens implant. The traditional cataract surgery method that has been used by most ophthalmologists over the past twenty five to thirty years is known as phacoemulsification. During this procedure, the eye is first anesthetized with topical gels and eye drops. Two small incisions of 2.5 mm or less are place in the edge of the cornea using blades. A circular opening is then created in the front of the cataract known as the anterior capsule using a bent needle and special forceps. The main portion of the clouded lens is then divided up and pulverized using a probe with ultrasound. The fragments of the lens are then vacuumed away. Once the cataract has been totally removed, a flexible intraocular lens implant is placed in a tiny tube and then injected into the eye. Once the injector is removed, the intraocular lens implant unfolds and assumes its normal conformation. Although this procedure has been constantly refined as technology improves, the basic procedure has not changed very much since its inception.
Cataract surgery has finally had a significant change over the past five years with the advent of the femtosecond laser. This cold laser technology allows one to cut through or dissolve tissue in a very precise and controlled manner with out using heat. There are several steps of cataract surgery that can be performed using the femtosecond laser.
First of all, very precise and perfect incisions can be performed using this laser technology eliminating the need for a blade. Even a calibrated diamond blade cannot produce an incision as precise as the femtosecond laser. Next, if one has astigmatism, this can often be treated during cataract surging by performing what is known as a limbal relaxing incision or LRI. An LRI is essentially a groove that is created in the cornea which relaxes tissue thereby decreasing astigmatism. Normally, LRI’s are created manually by the surgeon’s hand using a calibrated blade. The femtosecond laser can be used to create reproducible LRI’s of uniform depth, length, and curvature. As skilled as the surgeon may be, it is impossible to perform an LRI with the precision of the femtosecond laser.
Next, a perfectly circular shaped opening can be placed in the anterior capsule of the cataract using the femtosecond laser. An uninterrupted, continuous circular opening in the anterior capsule is crucial for proper positioning and support for the intraocular lens implant. Stable support and positioning is especially critical for specialty lens implants such as toric or multifocal intraocular lens implants. Finally, the femtosecond laser may be used to divide and soften the main portion of the cataract. This allows for easier separation and removal of the lens pieces especially if the cataract is very dense and hard. Also, this allows use of less ultrasound power which is potentially less traumatic to the eye.
Femtosecond cataract surgery is amazing technology that has made the procedure more precise, predictable, and possibly safer. If you are contemplating cataract surgery in the near future, please make an appointment today with one of our ophthalmologists for a thorough eye exam to see if you are a potential candidate for femtosecond cataract surgery.