If you’re age 60 and over, your ophthalmologist may have told you that you have a cataract in one or both eyes. They may also have told you that in the not too distant future you’ll have to think about removing it to improve your vision.

Many of my patients have asked me my opinion about the newer laser technology method of cataract removal surgery.  While traditional surgical cataract removal is the most commonly performed, and safe, surgery in America today, laser cataract removal has really advanced technologically.  And, it does have some significant advantages over traditional cataract surgery that you’ll want to weigh before deciding which one to choose. Here are the facts…

Cataract Removal:  The Advantages of ReLACS Over Traditional Surgery

Today, there are 6 types of FDA approved ReLACS (refractive laser cataract surgery) technologies used in the removal of cataracts.  From newest to oldest they include:

1.  LensAR. Cataract surgery
2.  Victus. Cataract removal as well as LASIK
3.  Catalys.  Cataract surgery
4.  iFS. Cataract surgery as well as used in LASIK vision improvement for several years
5.  LenSx. The first technology to gain FDA approval for cataract surgery

All the above systems are used in cataract removal. They have the ability to make a high precision anterior capsulotomy – an incision into the front of the capsule around the lens. The incision in the capsule exposes the cataract-afflicted lens of the eye.  It’s of critical importance to not damage the capsule during the incision as it will hold the artificial lens that will be inserted.

Research studies have shown a laser capsulotomy to be superior to the surgeon’s manual incision in terms of precision.  How well the capsulotomy is made in cataract surgery is crucial to how well the eye self-seals itself after the procedure.  Also, it determines the quality of vision and decreases the chance of the patient developing a retinal tear after the procedure.

Removing the cataract-containing lens is also done more safely with the laser.  In traditional surgery, the ultrasound used to break up the cataract into pieces can cause the incision to overheat and not heal properly.  It may also create astigmatism. Laser surgery, however, softens the cataract so that it’s broken up into smaller, softer pieces.  This greatly lessens the chance of burning the incision site.

Laser surgery is also more accurate than traditional surgery in placing the new intraocular lens implant (IOL). It allows the IOL to be more precisely centered which improves vision.

Traditional surgery capsulotomy is done with a diamond tip surgical blade by the ophthalmological surgeon. The precision of the incision largely depends on the surgeon’s skill gained through experience and how many times they’ve done the procedure.

In contrast, with laser surgery, the surgeon is able to precisely calibrate the capsulotomy incision with the use of computerized 3-D tomography called an OCT (optical coherence tomography).  Using the OCT and laser to make the cut, the issue of “surgeon skill” doesn’t come into play as the precise calibration of the tomography equipment overrides that.

These lasers utilize the same “femtosecond” laser used in vision improvement, LASIK surgery.  In fact, LASIK surgery has paved the way for laser cataract surgery.  It has lead to the increased safety, accuracy and predictability of surgical outcome in cataract surgery.

Another benefit of laser cataract surgery is that other visual issues like astigmatism and farsightedness can be fixed at the time of surgery with multifocal intraocular lens implants.

With all these benefits of laser cataract surgery, you’re probably wondering what are the drawbacks? Well, the biggest one is the cost. Since traditional cataract surgery is so commonly done in the U.S. today, most private medical insurances, as well as Medicare, will cover it almost completely.

With laser cataract surgery, however, there are extra costs associated with the use of expensive laser equipment surgery that are, unfortunately, not yet covered by most private insurances or Medicare.  You should plan on paying a few hundred extra per eye for laser cataract surgery.

But, just because traditional laser surgery has its limitations, that doesn’t mean that it’s inferior to laser surgery. You really just have to be sure you find a surgeon that’s had a lot of practice and is very skilled.  Word of mouth referrals may be the best but it’s important to ask a lot of questions and ask for prior patient opinions.

As I’ve explained, there are many desirable benefits of laser cataract surgery.  Ongoing technological advancements in the procedures occur frequently.  The ability to continually optimize the procedure gives it another advantage over traditional surgery.  I know if it ever comes time for me to have cataract surgery, I’ll be choosing the precision of laser to improve my vision.

In the meantime, you should do everything you can to naturally prevent cataracts from forming.  Please also see a prior newsletter article of mine, Sleeping and Cataracts Are Linked that will tell you how to prevent cataracts by sleeping better.

Stay Well,
Mark Rosenberg, M.D.

Presbyopia, http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/presbyopia?sso=y

Laser Cataract Surgery, http://www.allaboutvision.com/conditions/laser-cataract-surgery.htm