Laser Assisted Cataract Surgery A New Paradigm?

By David M. Benderson, MD

Maryland Eye Associates

. http://marylandeyeassociates.com

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Laser Assisted Cataract Surgery A New Paradigm?

Femtosecond lasers have been used for the past 12 years to create corneal flaps during LASIK surgery. These types of lasers are now available to assist in cataract surgery, in a procedure known as laser-assisted cataract surgery (LACS).

Traditional cataract surgery involves using a blade to create corneal incisions through which the eye is entered. The cloudy lens (cataract) is surrounded by a very thin clear bag known as the capsule. To access the lens, the surgeon must manually create a circular opening into this capsule. The lens is then removed using a high frequency ultrasound hand piece, known as phacoemulsification. A new, clear lens implant is then placed in the capsular bag.

In laser assisted surgery, the surgeon creates a laser treatment plan which is performed using the femtosecond laser. The femtosecond laser treatment is guided by real-time imaging of the eye, known as Ocular Coherence Tomography (OCT).

The femtosecond laser is used to create the corneal incision. This allows for the incisions to be created in a three-plane manner which are more likely to be self-sealing. The laser is also used to perform the capsular opening, resulting in a perfectly centered, perfectly sized capsulorrhexis which optimizes the alignment of the new lens implant. This is especially beneficial in the case of astigmatic correcting implants (toric) and multifocal lens implants. The laser also softens the cataract, allowing for easier removal using less ultrasound energy.

To provide the best visual outcome after cataract surgery, it is important to minimize any possible post-operative astigmatism. Most patients have some degree of astigmatism, which refers to the cornea being steeper in one axis resulting in a “football” shape, rather than a more spherical “basketball” shape. Significant residual astigmatism after cataract surgery can result in blurry vision necessitating glasses. In laser assisted cataract surgery, arcuate corneal incisions can be placed with a high degree of accuracy to reduce this astigmatism. While these types of incisions can also be performed manually, laser incisions are extremely precise in their size, depth and location. In contrast, manual corneal incisions are much less consistent and variably successful.

There are several laser-assisted cataract surgery platforms available now, including LenSx (Alcon), Catalys (AMO/OptiMedica) and LensAR. Whether the laser system is used to assist in placement of a premium lens implant (multifocal or toric lens) or to create arcuate/astigmatic-correcting incisions, there is an out-of-pocket expense not covered by Medicare or insurance.