#6 Femtosecond Laser Cataract Surgery

Overview

The eye is a complex organ that sends nerve impulses to the brain when stimulated by reflected light rays. The brain can then process these impulses and create the perception of vision.

The lens of the eye is a clear structure that stretches and contracts and allows us to focus on objects at various distances. With aging, however, cataracts, one of the most common eye ailments, can develop. These are dead cells that accumulate in the lens capsule, causing the lens to gradually become cloudy. As these spots increase in size, vision is no longer clear and sharp. The opaque areas on the lens make people feel as if they are now seeing everything through a fog-covered window.

In the United States, 75% of people over age 60 have some sign of cataracts. In most individuals any vision loss from cataracts can be corrected by surgery, which is a common, safe, and effective way of replacing the clouded lens. In fact, cataract surgery is the most commonly performed surgical procedure in the United States and is considered by many doctors to be the most effective surgical procedure in all of medicine. The American Academy of Ophthalmology estimates that 1.6 million cataract operations are performed each year in the United States.

Cataract surgery, called phacoemulsification, involves removing all or part of the damaged natural crystalline lens and replacing it with an intraocular lens implant to provide vision correction, often eliminating the need for eyeglasses or contacts. Cataract removal, which is done freehand with a surgical blade, will improve vision in more than 95% of cases if the eye is normal except for the cataract. 

While surgical results have been outstanding, cataract surgery has now been improved with the introduction of femtosecond laser technology. The device has already been used successfully in ophthalmology, particularly for LASIK (Laser In-Situ Keratomileusis) refractive surgery.

A femtosecond is one quadrillionth of a second. This is the super-fast amount of time that numerous laser pulses of near infrared light are used by a surgeon in this new cataract procedure. The femtosecond laser helps make a perfect circular hole in the lens capsule, splits the lens into sections, and then softens and breaks up the cataract. The damaged lens is removed using ultrasound and an intraocular lens is then implanted.

Unlike a surgical blade that cuts, a femtosecond laser separates tissue by ablating and cleaving it. The novel FDA-approved bladeless cataract procedure is now revolutionizing surgery by making it more predictable and accurate, allowing surgeons to make smaller, more precise incisions. It also requires less energy time inside the eye, causes less inflammation, and offers more stability when implanting a new lens.

The combination of precision and simplification that is possible with femtosecond laser represents a major advance for cataract surgery.

Where Are They Now

Using a femtosecond laser in cataract surgery is a slightly conflicting decision for both patients and professional because of the high costs associated with the laser. Studies have shown that cataract surgery with a femtosecond laser is superior to conventional cataract surgery, the extent of superiority has not been enough to completely replace less expensive, traditional surgery options. Study results released in January 2015 state that femtosecond laser-assisted cataract surgery and standard phacoemulsification cataract surgery appear to be equally safe. The first commercially available femtosecond laser installation occurred in 2016, and femtosecond laser cataract surgery now represents 35% of all cataract cases. As reported in 2016, ophthalmology currently represents an important market for manufacturers of laser and laser based systems.

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