Laser Cataract Surgery Steps, Costs & Improvements

Laser cataract surgery is becoming more available for patients, increasing chances of a complication-free surgery. Know the procedures, advancement and equipment used.

Cataract surgery is one of the most common eye surgeries. Because it is performed so frequently, it is often considered a safe and effective surgery, though the success of the procedure largely depends on the skill and experience of the surgeon. Laser cataract surgery brings good news for those suffering from poor vision at night and decrease in color perception, just to name a few of cataract symptoms.

Femtosecond laser technology has improved the accuracy, safety and predictability during LASIK surgery. This is also allowing for further advancements of cataract surgery.

What Does Cataract Surgery Include?

1. Cataract Incision

During the procedure your surgeon will use a metal or diamond blade to create an incision where the cornea meets the scleria which is around 2.5mm allowing the wound to heal without stitches after surgery. This incision will go vertically than horizontally to allow the surgeon access to the center of the eye, allowing them to break up and remove the cataract behind the pupil. Once this is completed the surgeon can insert an intraocular lens in its place.

When a laser is used the surgeon will create a surgical plan using a 3-D image of the eye known as an optical coherence tomography. This will allow them to determine the specific location of the incision as well as the length and depth of the planes. This information will be entered into the laser's programming so there is no need for freehand cutting. This increases both the accuracy of the incision while reducing the risk of infection and promoting self-healing after surgery.

2. Capsulotomy

During your cataract surgery a capsulotomy will be performed to remove the front portion of your capsule so the surgeon can gain access to your cataract. During a traditional surgical procedure, your surgeon will use a small needle to open the capsule and then tear the tissue with forceps to create a circular area to work in. The capsule will ultimately hold the artificial lens for the remainder of your life so it is vital that this area remain undamaged.

Studies indicate that using a laser to perform a capsulotomy is significantly more accurate than creating this opening by hand. The intracolular lens is much more likely to be centered and have proper positioning after the surgery is completed. This allows for a higher level of quality vision after the surgery is completed.

3. Removing the Cataract

Once the capsulotomy has been completed your surgeon will be able to remove the cataract. During a traditional cataract procedure, an ultrasonic device will be used to break up the cataract. This must be done carefully because energy from the ultrasound can cause heat buildup around the incision which can cause burning, increasing your risk of astigmatism and leaking around the sutures after the procedure. In general, smaller incisions reduce the risk of these side effects.

Using a laser to soften the cataract will help to break it up into smaller pieces using less energy, reducing your risk of distorting the incision or burning the tissue. Using less energy to break up the cataract also reduces the risk of damage to the inner eye such as detached retina. This also reduces the risk of capsule damage. Calculating the proper implant power is essential to preserving the capsule so the lens will sit properly and allow the artificial lens to focus properly.

4. Astigmatism Correction

In order for an advanced intraocular lens to be effective, your cataract surgery must cause minimal astigmatism. This is caused by your cornea being curved farther on one axis than the other, so creating proper incisions is essential to creating the proper shape for your cornea. A hands-free diamond blade is particularly effective in lowering the risk of astigmatism.

Refractive laser-assisted cataract surgery can help to plan the depth, length and location of the incisions so that the laser can create the most accurate cuts possible. This minimizes the variables that could cause damage, ensuring a reproducible and accurate incision.

Watch a video to see exactly how the procedures would be using lasers:

Costs of Laser Cataract Surgery

In most cases refractive laser-assisted cataract surgery is more expensive than conventional options because of the costs associated with maintaining the necessary equipment. The specific fees associated with this surgery will vary from facility to facility. In general, a laser assisted surgery costs a few hundred dollars more than a traditional procedure. Usually these extra costs will be covered by your health insurance or Medicare.

Improvements in Cataract Surgery

The continuous improvement technique has helped to improve cataract surgery. A laser makes a zigzag motion during the procedure that is impossible for a human hand to make. This will help the tissue interlock to improve your chances of healing comfortably after your surgery. The improvements of using lasers for cataract surgery are still being investigated and implemented for patients.

Laser Cataract Surgery Systems

The following are several major laser cataract surgery systems. Some of them are FDA-approved while some are still in development.

  • LenSx. This was the first femtosecond laser system that was approved for use on cataracts. Currently, this system is approved for use on the anterior capsulotomy, fragmenting the cataract and making incision on the corneal plane.
  • LensAR. This is one of the most recent systems to earn approval for use in lens fragmentation, the anterior capsulotomy, corneal incisions and arcuate incisions.
  • Catalys. This system is approved for lens fragmentation and capsulotomy.
  • IFS. This femtosecond laser can be used to create curved arculate or bow-shaped incisions. It has also been used for years to create the flap for LASIK procedures.
  • Victus. This system was launched in Europe in 2011 and was approved for use in the U.S. in 2012. It has been cleared for corneal flap creation during LASIK, arcuate corneal incisions and anterior capsulotomy during cataract surgery.
  • Femto LDV Z6. This device is used for a wide variety of eye surgeries but has not yet been approved for use on cataracts
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