“Laser” Cataract Surgery

By Jacqueline Griffiths, MD

A cataract is a clouding of the lens inside the eye, causing vision loss that cannot be corrected with glasses, contact lenses or corneal refractive surgery like LASIK.

In cataract surgery, the lens inside your eye that has become cloudy is removed and replaced with an artificial lens (called an intraocular lens, or IOL) to restore clear vision.

The procedure typically is performed on an outpatient basis and does not require an overnight stay in a hospital or other care facility. Most modern cataract procedures involve the use of a high-frequency ultrasound device that breaks up the cloudy lens into small pieces, which are then gently removed from the eye with suction.

What Is the Femtosecond Laser?

Recently, a number of femtosecond lasers similar to the lasers used for LASIK have been approved by the FDA for use in cataract surgery to do the following steps:

Creating corneal incisions to allow the surgeon access to the lens
Removing the anterior capsule of the lens
Fragmenting the cataract (so less phaco energy is required to break it up and remove it)
Creating peripheral corneal incisions to reduce astigmatism (when needed)

A femtosecond laser can also be used to perform some of the steps of surgery to remove a clear lens or refractive lens exchange (RLE), and to make arcuate incisions in the cornea (AK) to reduce astigmatism. There are benefits and risks associated with the use of the laser, and there may be additional costs.

Lasers vs. Traditional Surgery To Remove the Lens

What Are the Possible Benefits?

Traditionally, the eye surgeon uses blades to create the incisions in the cornea (the front window of the eye), and other special instruments to create the capsulotomy (the circular incision in the outer layer of the cataract or clear lens). The surgeon also uses a phacoemulsification device that utilizes ultrasound power to break up the lens and remove it from the eye. The femtosecond laser can be used to perform some or all of these steps.

The possible benefits of the laser include the ability to make more precise and consistent incisions in the cornea, a more circular and centered capsulotomy, and to pre-soften the cataract so less ultrasound energy is necessary with the phacoemulsification device.

How Is the Laser Used To Treat Astigmatism?

Patients with astigmatism have several choices for the reduction of astigmatism. Nonsurgical options for astigmatism correction include glasses and contact lenses. Surgical correction of astigmatism can be achieved through a toric intraocular lens, a limbal relaxing incision (LRI) made manually with a blade, or an arcuate incision made with the femtosecond laser (AK). Refractive surgery such as LASIK or PRK can also treat astigmatism. The shape and size of incisions made with the laser may be more precise.