Cataract surgery is the procedure to remove your natural eye’s lens when it is cloudy.

The purpose of your lens is to curve or refract light emissions that come into the eye to help you perceive. Your own natural lens must be clear, but with this condition it is cloudy. Having a cataract can be like watching through a foggy or dirty car windshield. Stuff may look blurred, foggy or less colorful.

The only way to eliminate a cataract is with surgery. Your ophthalmologist removes a cataract when it keeps you from doing activities of daily living you want or must do.

Throughout the cataract surgery, your cloudy normal lens is removed and replaced with a clear artificial lens, called “intraocular lens (IOL)”. Your ophthalmologist will dialog with you about IOLs and how it works.

Here’s what you need to know about laser cataract surgery:

What is laser cataract surgery?

Many of the stages of cataract surgery are conventionally performed using handheld apparatuses. Nowadays, they can be accomplished with the precision of a laser. The surgeon can use the laser to craft specific incisions, as well as the round opening for retrieving and removing the cataract. The opening is remarkably exact and outcomes are improved.

When the opening is shaped, the laser then unstiffens and breaks up the hard cataract into small pieces, permitting for milder, easier cataract removal with suggestively less ultrasound energy than is used in old-style cataract surgery.

How laser cataract surgery is performed?

There are three main steps performed during the laser cataract surgery and these include:

1. Corneal incision
2. Anterior capsulotomy
3. Lens and cataract fragmentation

Here are the details of each of these steps:

The Corneal Incision:

The first step in the procedure of cataract surgery is the creation of an incision in the cornea.

In the traditional cataract surgery, the eye surgeon makes an incision in the area where the cornea and the sclera (white part of an eye) meets by using a hand-held metal or blade. This incision allows the surgeon to access the cataract which is then broken up and removed. After that, IOL is implanted.

The incision in the cornea is made in such a way that it seals itself after the surgery and therefore no stitches required.  

In the cataract surgery by laser, the surgeon creates a defined surgical plan with the help of a 3-D image of an eye that is called as “optical coherence tomography or OCT” (it is basically an imaging method in which light waves are used to show the cross-sectional image of interior structure of an eye). The use of OCT method helps the surgeon to create an incision with the most definite location, depth, and distance in all planes. As a result of using the OCT method and femtosecond laser (a device that creates laser energy to precisely target the cloudy tissue without damaging the nearby areas), the step is performed accurately.  

Making a corneal incision in this way is imperative not only because it provides accuracy but also it allows the incision to self-seal that reduces the risk of infection afterward.

The Anterior Capsulotomy:

The natural lens of the eye is surrounded by a clear and very thin capsule. During the second step of the surgery that is called anterior capsulotomy, the front portion of the capsule is removed. This gives the access to the cataract.

It should be taken care of that the remaining portion of the lens capsule which remains intact in an eye doesn’t get damaged during the procedure. The reason is that this capsule – as thin as cellophane wrap – will hold the implanted artificial lens in proper position for the rest of the life of the patient and gives a clear, accurate vision.  

In traditional cataract surgery, an eye surgeon uses the same needle to create an opening in the capsule and then to tear the capsule in a circular manner.

On the other hand, in laser-assisted cataract surgery, the step of anterior capsulotomy is performed using a femtosecond laser.  

Studies have shown that the anterior capsulotomies performed with laser are more accurate and allow better positioning of IOL because the positioning of IOL determines the final visual results.

Lens and Cataract Fragmentation:

After the anterior capsulotomy, the eye surgeon has direct access to the cataract so that it can be removed.

In traditional cataract surgery, the procedure called phacoemulsification is performed in which ultrasound energy is used to insert in the incision, breaks up and removes the cataract. But ultrasound energy can build up the heat in the incision which sometimes may burn the incision and therefore have negative effects on the visual outcome.

The laser energy softens the cataract and then breaks it up into smaller pieces. As it breaks up cataract into softer and smaller pieces, so less energy is needed to remove the cataract and as a result, there will be no risk of burning and deforming the incision.

The reduced laser energy, used in the laser-assisted cataract surgery makes the entire procedure safer for the inner eye and thus reduces the risk of complications such as the detached retina.  

What are some common laser cataract surgery systems used to perform the surgery?

Below are the FDA approved systems for the laser-assisted cataract surgery that are currently available in the USA:

LenSx: The foremost system of femtosecond laser from Alcon has gained FDA approval to perform the cataract surgery in the USA. This system is used for the corneal incisions, anterior capsulotomies, and cataract fragmentation. According to Alcon, more than 400,000 procedures of cataract refractive surgery were performed globally by using LenSx.

LensAR: This system from LensAR, Inc. has got approval to be used for the corneal incisions, anterior capsulotomies, and cataract (lens) fragmentation. The “AR” stands for “Augmented Reality” and according to the company, it means an imaging technology which gathers the data to rebuilds a 3-D picture of the structure of an eye of every individual patient.

Catalys: This laser system from Abbott Medical Optics is FDA-approved to perform the three main steps in the cataract surgery by laser: corneal incision, anterior capsulotomies and lens, and cataract fragmentation. According to the company, this system provides gentle application of laser to an eye thus reducing the risk of high pressure inside the eye during the surgery.

Victus:  This platform from the company Bausch + Lomb is also FDA-approved to perform the cataract surgery by laser (corneal incision, capsulotomy, and fragmentation). According to the company, this system has the feature to minimize the risk of eye distortion and allows a very accurate alignment.

Femto LDV Z8: Ziemer Ophthalmics produced this system with femtosecond laser technology and the company claimed that this system has many advantages such as:

• The laser beam has a high repetition rate that makes the procedure fast,
• The laser energy per pulse is very low for making the treatment gentle, and
• The overlapping of the laser spots allows high accuracy and predictability.

What are the benefits of laser cataract surgery?

Using femtosecond laser provides numerous laser cataract surgery benefits and these include:

Precision:

The 3-D measurements and computerized mapping for preparing the eye provide precise specifications that help to achieve precise results after the procedure. Secondly, the real-time visualization during the surgery helps the eye surgeon for a proper and accurate positioning of the lens.

Bladeless:

Laser-assisted cataract surgery is the minimally invasive procedure and it offers the help of the latest technology to make the incisions and fragmenting the cataract. Due to the use of the technology and laser systems, no traditional blade is used. The laser energy provides complete accuracy for the best visual outcomes.    

Customization:

The cataract surgery by laser provides a customized treatment plan according to the conditions of each and every patient. The eye surgeon designs a particular plan to the eye map of each patient. The computerized planning eliminates all the guesswork or presumptions from the procedure and this provides successful results. The eye of each patient is thoroughly scanned for the measurements and then the data is interpreted into the personalized plan that is custom-built for each and every patient individually.   

What is the cost of laser cataract surgery?

The cost of laser cataract surgery is more than the cost of traditional cataract surgery. The approximate cost of only the laser itself is around $300,000 to $500,000 and the additional costs are separate for the usage and maintenance of the laser device.  

It is unlikely that the additional costs of the surgery are covered by Medicare or other private-health insurance. The laser cataract surgery cost varies depending on the individual cataract specialist.

Conclusion:

Laser-assisted cataract surgery is the new innovative technology that gives the best visual outcomes. The more precision, accuracy, use of laser systems and correction of astigmatism may help the patient to achieve the goal of very less dependency on the glasses after the surgery.

To know whether laser cataract surgery is the right treatment option for removing your cataracts, consult cataract surgeon and ask for more information about this remarkable technology.