Laser Cataract Surgery

Last updated on April 26th, 2017 at 04:24 am

The femtosecond laser technology that brought brand-new levels of safety, accuracy and predictability to LASIK surgery is also advancing cataract surgery. In our office, we call the procedure Refractive Laser-Assisted Cataract Surgery (ReLACS), but it likewise is understood typically as laser cataract surgery.

Laser Cataract Surgery Basics

In laser cataract surgery, an advanced femtosecond laser changes or assists use of a hand-held surgical tool for the following actions in cataract surgery:

  1. The corneal cut
  2. The anterior capsulotomy
  3. Lens and cataract fragmentation

Use of a laser can enhance the accuracy, precision and reproducibility of each of these actions, possibly decreasing dangers and improving visual outcomes of cataract surgery.

The Corneal Incision

Standard cataract surgery is one of the most regularly carried out surgeries as well as one of the most safe and efficient, with predictable outcomes. It is extremely dependent on surgeon skill, volume and experience.

The primary step in cataract surgery is making an incision in the cornea. In standard cataract surgery, the eye cosmetic surgeon uses a hand-held metal or diamond blade to develop a cut in the area where the cornea fulfills the sclera. This incision enables the cosmetic surgeon to gain access to the interior of the eye to break up and eliminate the cataract, which is a clouding of the eye’s natural lens that is located right behind the pupil. Next, an intraocular lens (IOL) is placed and implanted, to replace the cloudy natural lens.

See also: Corneal Transplantation Surgery

The corneal cut is made in unique method so it will self-seal when surgery is total, with no requirement for stitches.

In laser cataract surgery, the surgeon develops an accurate surgical prepare for the corneal cut with a sophisticated 3-D picture of the eye called an OCT (optical coherence tomography). The goal is to develop a cut with a specific place, depth and length in all airplanes, and with the OCT image and a femtosecond laser, it can be performed exactly without the variable of surgeon experience.

This is essential not only for precision however likewise for increasing the likelihood that the cut will be self-sealing at the end of the procedure, which minimizes the risk of infection.

Laser Cataract Surgery

The Capsulotomy

The eye’s natural lens is surrounded by a really thin, clear pill. In cataract surgery, the front portion of the capsule is removed in an action called an anterior capsulotomy, to access to the cataract.

It is extremely important that the remainder of the lens pill that stays intact in the eye is not damaged during cataract surgery, due to the fact that it must hold the artificial lens implant in place for the remainder of the patient’s life.

In conventional cataract surgery, the cosmetic surgeon develops an opening in the capsule with a small needle and then uses that same needle or a forceps to tear the pill in a circular style.

Also read: Cataract Surgery Recovery Time and Care Tips

In laser cataract surgery, the anterior capsulotomy is carried out with a femtosecond laser. Studies have actually shown that capsulotomies carried out with a laser have greater accuracy and reproducibility.

Studies also have revealed that laser capsulotomies make it possible for better focusing of the intraocular lens, and IOL placing is a considerable consider identifying last visual outcomes.

Lens And Cataract Fragmentation

After the capsulotomy, the surgeon now has access to the cataract to eliminate it. In conventional cataract surgery, the ultrasonic device that separates the cataract is inserted into the cut. During this phacoemulsification procedure, the ultrasound energy can cause heat accumulation in the cut, which often can burn the incision and negatively affect the visual result by in fact inducing astigmatism.

An incision burn also has a higher possibility of leaking and in some cases needs multiple sutures to close. The smaller sized the cut we use, the more this issue is important to think about.

The laser, on the other hand, softens the cataract as it breaks it up. By separating the cataract into smaller, softer pieces, less energy needs to be had to get rid of the cataract, so there ought to be less possibility of burning and distorting the incision.

See also: Cataract Surgery Lenses

Laser cataract surgery might likewise minimize the risk of pill damage. After the calculation of the correct implant power, there is no action more vital for visual result than preservation of the capsule that the natural lens sat in. This capsule is as thin as cellophane wrap and it’s important that the part that is left inside the eye after cataract surgery is intact, so it can hold the IOL in the correct position for clear, undistorted vision.

The decreased phacoemulsification energy needed in laser cataract surgery may also make the procedure much safer to the inner eye, which reduces the chance of certain complications, such as a detached retina.

Astigmatism Correction At The Time Of Cataract Surgery

To decrease the requirement for prescription eyeglasses or reading glasses after cataract surgery, it is important that little or no astigmatism exists after implantation of presbyopia-correcting multifocal IOLs and accommodating IOLs.

Astigmatism usually is brought on by the cornea being more curved in one meridian than others (to puts it simply, it’s shaped somewhat like a football). To decrease astigmatism, little incisions can be placed in the periphery of this more curved meridian; as the cuts heal, this meridian flattens somewhat to give the cornea a rounder, more in proportion shape (like a baseball).

You might be interested in: LASIK Surgery for Astigmatism: Does It Work?

This procedure is called limbal relaxing cuts (LRI) or astigmatic keratotomy (AK). Surgeons can perform LRI or AK manually with a diamond blade, and it is rather efficient in minimizing astigmatism.

During refractive laser-assisted cataract surgery, the OCT image can be used to plan laser LRI or AK cuts in an extremely precise area, length and depth. This increases the accuracy of the astigmatism-reducing procedure and increased the likelihood of excellent vision without glasses after cataract surgery.

Laser Cataract Surgery Systems Currently Available

A variety of medical device companies around the world manufacture systems for carrying out laser cataract surgery. Systems that have actually obtained FDA approval and are currently available for laser-assisted cataract surgery carried out in the United States include:

  • LenSx. The LenSx system (Alcon) was the first femtosecond laser system to acquire FDA approval for cataract surgery performed in the United States. The LenSx system is authorized for corneal cuts, capsulotomies and lens (cataract) fragmentation and has been used in more than 400,000 cataract refractive treatments worldwide, inning accordance with Alcon.
  • LensAR. The LensAR Laser System (LensAR, Inc.) is authorized for corneal incisions, capsulotomies and lens (cataract) fragmentation. The “AR” mean “Augmented Reality,” which describes exclusive imaging innovation that gathers an unmatched spectrum of biometric information and then rebuilds an advanced 3-D model of the anatomy of each patient’s eye, according to the company.
  • Catalys. The Catalys Precision Laser System (Abbott Medical Optics) likewise is FDA-approved for the 3 main actions prior to IOL insertion in laser cataract surgery (corneal cut, capsulotomy and lens fragmentation). The Catalys system likewise includes a liquid optics interface that provides gentle docking of the laser to the eye, minimizing threats connected with high eye pressure during laser cataract surgery, according to AMO.
  • Victus. The Victus Femtosecond Laser Platform (Bausch + Lomb) also is FDA-approved for corneal incisions, capsulotomy and lens fragmentation in laser cataract surgery. The Victus system features exclusive Advanced Docking Technology that lessens the possibility of eye tilt or distortion and allows accurate positioning designed to maintain the natural shape of the eye during laser-assisted cataract surgery, according to the company.

Cost Of Laser Cataract Surgery

Refractive laser-assisted cataract surgery costs more than standard choices. The laser itself can cost the cosmetic surgeon around $300,000 to $500,000, and extra expenses are connected with utilizing and preserving the device.

Costs vary from one cataract surgeon to another, but it is most likely you would pay a few hundred dollars additional per eye out-of-pocket for a laser-assisted procedure.

Cataract cosmetic surgeons who use lasers say that their advantages are especially obvious when it comes to high-tech, exceptional implants such as presbyopia-correcting multifocal IOLs and accommodating IOLs. The advantages can include better lens positioning and for that reason more precise visual outcomes.

Also read: Costs of Cataract Surgery

Conclusion

It is essential to put this brand-new innovation into correct viewpoint. Standard cataract surgery is very efficient and successful. Individuals who do not wish to invest out-of-pocket cash in laser cataract surgery can still feel confident about the traditional technique.

However if you desire the best possible vision, laser cataract surgery is appealing. A more accurate incision, capsulotomy and astigmatic correction may assist you achieve your goal of less reliance on glasses after cataract surgery.

To decide if laser cataract surgery is the best choice for you, ask your cataract surgeon for more information about this exciting technology during your preoperative examination and assessment.

Like this post? Please share to your friends:
Comments: 1
  1. Randy Bennett

    I had cataract surgery two weeks apart in December 2016. Besides having problems from my eyes being dilated when I came home, I had no issues at all. I now do not need glasses or contacts. That was remarkable to me because my prescription was extremely high prior to the surgery. I believe that individuals who have bad experiences need to have selected a different doctor. I was lucky enough to have a surgeon who is at the leading eye health center in the country. I am pleased with the surgery. I wish fantastic sights for all.

Leave a Reply