The lowdown on Laser Assisted Cataract Surgery
Ok you’ve been told you have a cataract and that having cataract surgery is the best way to improve your vision….now comes the hard part. Not only does your doctor have to decide whether a specialty lens is appropriate but also whether to perform the surgery using traditional surgical technique or laser assisted. Each choice will have a cost and a benefit and no one choice is correct for everyone. Assuming there are no additional factors such as retinal disease, corneal disease, previous refractive surgery such as radial keratotomy or underlying systemic disease such as moderate or advanced diabetic or renal disease and that both eyes are either ready or will be ready within a reasonable timeframe. In addition there are predisposing factors such as irregular corneal astigmatism, previous cataract surgery in one eye, a large difference in refractive error between the two eyes, previous mono vision contact lens wear or a personality that can’t handle much change. Some patients have great outcomes (20/20+ vision) but may still be bothered by glare, halo’s or other artifacts of the intra-ocular lenses (lenses used to replace the haze cataract) and some types of lenses such as diffractive multifocal lenses have a higher incidence of glare and halos.
Probably first on the decision making list should be lifestyle. Are you an active patient who likes to hike, golf, drive or play tennis or is your passion reading, computer work or a similar close/near environment. Maybe you want to have it all and be able to read, drive and do computer work without any lenses. Did I say without glasses? Yes, most of the newer technology is designed to either more accurately perform cataract surgery or to provide more precise vision outcomes following cataract surgery. That usually means minimizing (or eliminating) the need for glasses.
The latest change is the actual surgical steps being replaced by a laser. Those steps are as follows:• incisions into the cornea (to allow access for the lens and saline solution as well as correcting for astigmatism) • opening up the lens membrane surrounding the hazy lens cortex (called anterior capsulotomy)• lens fragmentation – softening and breaking up the cataract• lastly but not a typical step is the intra-surgical assessment of optical power calculations. That means assessing the actual power of the eye during the surgery to ensure the lens that is placed in the eye is the most accurate possible. This is typically packaged with laser assisted surgery but can be a stand alone option.The benefits of Laser assisted cataract surgery include lens time “in the eye” by the surgeon as well as less overall energy in the form of ultrasound energy released in the eye. In addition a reduced risk of an anterior capsule tear and more accurate incision size and placement. The placement of the lens in the eye is currently thought to be the biggest factor in providing the best outcomes. Laser assisted power calculations help more accurately determine placement of specialty lenses such as astigmatic correcting lenses and overall power. The laser potentially can reduce induced astigmatism and can correct for astigmatism at the time of initial surgery without a second procedure. Complications associated with Laser assisted surgery include :• loss of suction during the procedure or improper docking of port• incomplete capsulorhexis (opening the front “bag or capsule of the lens”• conjunctival hemorrhage (often due to the docking port)• anterior capsule tag, tear or bridge• the need for additional incision by a keratome (blade)• capsular block due to trapped gas (created by the laser)Overall studies have shown the rate of complications is reduced by half once a surgeon has completed his first 100 cases. This confirms that there is a learning curve for this new technology.The risk of a posterior capsular tear in an experienced surgeon is less than half of the normal rate of capsular tear for surgery without the laser (2% in general use .31% in laser surgery)
Summary: Laser Assisted surgery along with other improvements may benefit patients in obtaining an optimal post cataract outcome. Each patient has to be evaulated individually to assess the benefit of not only this new technology but also the type of lens. When the goal of the patient is reached cataract surgery is considered successful.