Laser Cataract Surgery: Why do Patients Prefer Laser Cataract Surgery?

Why do Patients Prefer Laser Cataract Surgery?

Femtosecond Laser Cataract Surgery or Laser Assisted Cataract Surgery  (LACS)

A few years ago, as of about 2010, no one had a real choice on what type of cataract surgery to have.

The only options were:
1. Intracapsular cataract surgery: a very traumatic, archaic surgery requiring the surgeon to cut open 1/3-1/2 of the eye along the corneal limbus (where the clear cornea meets the white sclera) and use a loop to pull out the cataract and its capsule (the "pillowcase around the pillow" analogy where the cataract is the "pillow"). This lead to many complications and a very long recovery time.
2. Extracapsular cataract extraction: a less traumatic, less archaic, surgery where a surgeon opens 1/3-1/2 of the eye along the corneal limbus (where the clear cornea meets the white sclera) and uses a loop to  pull out the cataract, after an opening in the anterior capsule (the "top part of the pillowcase") has been open with slits or a continuous circular openening (ie, continuous capsulorhexis).
3. Phacoemulsification ultrasound cataract surgery: a real innovation that allowed for surgeons to make a very small incision in the eye (in the sclera [white part of the eye] or better yet, the cornea [the clear window of the eye]. Too much phaco ultrasound, however, can damage other parts of the eye as explained below. 

In 2008, a Femtosecond Laser procedure was first used clinically in cataract surgery by Professor Zoltan Nagy in Budapest, Hungary (Europe). This was followed by Dr Steven Slade in the USA (2010) and Dr. Harvey Uy in Asia (2009) and Dr Michael Lawless in Australia (2011)

A femtosecond is the SI unit of time equal to 10⁻¹⁵ or ¹/_{1,000,000,000,000,000} of a second. That is one quadrillionth, or one millionth of one billionth, of a second. A femtosecond laser is a super fast laser which emits optical pulses with a duration well below 1 ps (→ ultrashort pulses), i.e., in the domain of femtoseconds (1 fs = 10⁻¹⁵ s). It thus also belongs to the category of ultrafast lasers or ultrashort pulse lasers.

The Femtosecond Laser does the following key things during surgery:
1. Assist or replace several aspects of the manual cataract surgery.
2. It creates the initial surgical incisions in the cornea
3. It creates the capsulotomy (the circular cut in top capsule ["top part of pillow case"]
a. This perfect opening has been shown to improve the stability of the implant placed long term: which improves vision outcomes in general.
4. It fragments (breaks up) of the lens. This decreases the total phacoemulsification ultrasound energy needed to remove the cataract. Too much ultrasound energy can damage important internal eye structures, such as the corneal endothelial cells and macular cells, both of which are key in giving us good long term vision. 
5. Produce incisions within the peripheral cornea to aid the correction of pre-existing astigmatism.

The preliminary results are promising
 
Femtosecond lasers have been used successfully in ophthalmic surgery since 2001. The technology has been applied widely, most notably in LASIK (Laser In-Situ Keratomileusis) refractive surgery. In FemtoLASIK the laser replaces a mechanical device (microkeratome) to create a precise corneal flap preparing the eye for the secondary laser ablation in order to change the patient’s refractive error. There are several benefits; Femtosecond lasers have been noted to be more precise than microkeratomes, with fewer likely collateral tissue effects. This has contributed to more precise, reproducible and safe LASIK outcomes.

Femtosecond Laser Cataract Surgery is not covered by insurance and thus is an out of pocket expense. Currently, we charge $1150 per eye for this technology as of August 2015. If you were to ask 1000 eye surgeons if they would choose this technology on their eye, 998-1000 would say yes. If money were not an issue, most eye surgeons would want all their patients to have this technology given its benefits.

Time will tell whether Femtosecond Laser Cataract Surgery improves long term visual outcomes, decreases recovery time, improves the time a patient gets to 20/20 vision, decreases CDE (cumulative dispersive energy: the amount of phaco ultrasound energy pumped into the eye: so far I have seen this to be the case), decreases risk of rebound iritis (inflammation), decreases risk of macular edema, decreases risk of implant dislocation long term, decreases the risk of vitreous loss.

If I had to choose, I would choose Femtosecond Laser Cataract Surgery.

One last note on making your vision as perfect as possible after cataract surgery: We know that the tear film is essential to improving the quality of vision. The tear film depends on 3 layers which are very important: the meibomian glands produce the oily part (which is essential); the aqueous from the lacrimal gland; and the mucin layer from the goblet cells on the conjunctiva. We always want to keep the eyelashes clean by using the lid hygiene routine discussed in my blog. Some of the best products for this are noted below: Tea Tree Oil (Cliradex is a towelette of tea tree oil that works great: though have to use a warm compress first to open the meibomian gland, use a piece of Cliradex, scrub the eyelashes like you are gently brushing your teeth. Sometimes you need to dilute the Cliradex so it does not burn as much). Just to note below another natural product I use and love (though sometimes, I have to dilute it a bit so it does not burn): Tea Tree Oil. Using it in this little towelette works great when starting to use Tea Tree Oil. My favorite is below.