Traditional cataract surgery is one of the most frequently performed surgeries and also one of the most safe and effective, with predictable outcomes. It is highly dependent on surgeon skill, volume and experience.
Laser cataract surgery takes reliability to a new level, providing better accuracy, better healing, reduced capsule breakage and better centering of the IntraOcular Lens (IOL).
Traditional cataract surgery is one of the most frequently performed surgeries and also one of the most safe and effective, with predictable outcomes. It is highly dependent on surgeon skill, volume and experience.
In traditional cataract surgery, the eye surgeon uses a hand-held metal or diamond blade to create an incision in the area where the sclera meets the cornea. The goal in creating this incision is to go a partial depth vertically, then go horizontally in the cornea about 2.5 mm and then enter into the eye. Then the surgeon can break up and remove the cataract, which is located right behind the pupil. Next an intraocular lens (IOL) is inserted and implanted, to replace the cloudy natural lens.
The reason cataract incisions are created in a two- or three-plane fashion is so they will self-seal when surgery is complete, allowing for a no-stitch approach.
With the laser approach to cataract surgery, the surgeon creates a precise surgical plan with a sophisticated 3-D image of the eye called an OCT (optical coherence tomography). The goal is to create an incision with a specific location, depth and length in all planes, and with the OCT image and a femtosecond laser, it can be performed exactly without the variable of surgeon experience.
Optical coherence tomography is an imaging technology that helps your cataract surgeon to plan the location and depth of incisions made during a laser-assisted cataract surgery procedure. OCT scans offer high-resolution and even cross-sectional images, to make the cataract surgery as precise as possible.
This is important not only for accuracy but also for increasing the likelihood that the incision will be self-sealing at the end of the procedure, which reduces the risk of infection.
The eye's natural lens is surrounded by a capsule that is very thin and very clear. In cataract surgery the front portion of the capsule is removed in a step called the capsulotomy, to gain access to the cataract.
It is important that this capsule not be damaged during the cataract surgery, because it must hold the artificial lens implant in place for the rest of the patient's life.
In traditional cataract surgery, the surgeon creates an opening in the capsule with a small needle and then uses that same needle or a forceps to tear the capsule in a circular fashion.
The opening should be a continuous tear that is 5 to 6 mm in diameter and well-centered for optimal implant fit. Studies have already shown that this very important capsulotomy step works better with the laser in terms of accuracy and reproducibility.
Studies have also shown that laser capsulotomies enable better centering of the intraocular lens (IOL), and IOL positioning is a significant factor in determining final visual outcomes.
After the capsulotomy, the surgeon now has access to the cataract to remove it. In traditional cataract surgery, the ultrasonic device that breaks up the cataract is inserted into the incision. During this phacoemulsification procedure, the ultrasound energy can lead to heat buildup in the incision, which sometimes can burn the incision and negatively affect the visual outcome by actually inducing astigmatism.
An incision burn also has a higher chance of leaking and sometimes needs multiple sutures to close. The smaller the incision we use, the more this issue is important to consider.
The laser, on the other hand, softens the cataract as it breaks it up. By breaking up the cataract into smaller, softer pieces, less energy should be needed to remove the cataract, so there should be less chance of burning and distorting the incision.
Using the laser should also result in less chance of capsule breakage. After the calculation of the proper implant power, there is no step more important for visual outcome than preservation of the capsule that the natural lens sat in. This capsule is as thin as cellophane wrap and is important to leave undamaged so that it can hold the artificial lens implant in the proper position for the best ability to focus.
The reduced energy of the laser may also make the procedure safer to the inner eye, which reduces the chance of certain complications, such as a detached retina.
