For many patients about to undergo cataract surgery, it can be difficult to sift through the many surgery options they are presented with. Perhaps the most important decision for patients is to choose between traditional cataract surgery and bladeless cataract surgery. While both options are safe and well practiced by many ophtalmologic surgeons, many patients require more information to make a more informed decision about their personal surgery.
Cataract surgery involves the removal of the lens inside the eye after it has become cloudy due to aging, injury, etc. Upon it’s removal, it is replaced with an intraocular lens to restore the patient’s vision. Typical cataract surgery involves four basic steps, all of which are more accurately and efficiently completed with the help of the femtosecond laser.
The first step of the surgery is to create the corneal incisions, usually in the periphery of the cornea. This allows the surgeon to access the cloudy lens inside the eye. In bladeless cataract surgery, these incisions are made with a laser. Next, the surgeon will perform an anterior capsulotomy, which involves creating an opening in the front of the lens capsule, the thin sack which contains the cloudy lens to be removed. This step is also completed with a laser, which creates a perfectly centered incision. After this, the surgeon must break up the cloudy lens into small pieces so they can be removed through the corneal incision. In traditional cataract surgery, this is done with an ultrasonic probe; in bladeless cataract surgery this step is accomplished with the use of the laser. Once the cataract has been removed, the natural lens is replaced with an intraocular lens, such as a multifocal IOL or an accommodating IOL. Due to the precision with which the previous steps of the surgery were completed the IOL will be more centered and have a tighter fit, which reduces the chance of lens shift. This is increasingly important as more multifocal and accomodating lenses are being used, and need to be aligned more precisely to function properly.
The use of femtosecond lasers in vision correction surgery has become commonplace over the last decade or so. Millions of people have opted to get LASIK surgery to correct vision issues such as nearsightedness, farsightedness, and astigmatism. The possibilities and benefits of using similar bladeless technology in cataract surgeries were apparent upon the introduction of LASIK eye surgery, but extensive research and testing had to be completed first.
For the femtosecond laser to be effective in use during cataract surgery, which involves cutting tissue deeper within the eye, it needed to be able to reach an intensity strong enough to ionize the tissue at the selected focal point as well as pulse energy and power low enough to avoid damaging other eye tissues, the retina, or other parts of the eye. The femtosecond laser uses a near infrared light to create precise subsurface cuts on the eye. It works independently of how much light the eye tissue can absorb, unlike other lasers, so access to deeper tissues is possible and the anatomy of the patient’s eye (shape, thickness, etc.) does not interfere with the cuts. The pulses of the laser are very short which allow lower energy levels, which in turn decreases collateral damage.
One of the numerous benefits of using this advanced bladeless technology is the further standardization of the cataract surgical process as a whole. Researchers used optical coherence tomography, a non contact, non invasive, in-vivo imaging technique in order to obtain a 3D rendering of the eye, which they then used to develop software that pinpoints the ideal pattern for the laser to follow during surgery. This pattern is then superimposed onto a 3D picture of the actual patient’s eye, so that the surgeon can review and confirm that he is on the right track prior to surgery. This allows for a more predictable and accurate surgery.
While traditional cataract surgery already boasts a remarkably high success rate with effective results, the use of femtosecond lasers help to assure more predictable results as well as further standardization of the surgical process. This allows surgeons to perform more surgeries in a day. The cuts made with the femtosecond laser are more precise, which allows for tighter-closing wounds, reduced risk of infection, speedier recovery, and better overall results.
Of the four companies developing the lasers for cataract surgery, LenSx received the first laser clearance from the FDA. They then selected Stephen Slade MD of Vision Texas to perform the first bladeless cataract surgery, which was successfully completed on March 10, 2010. WIth the increased precision, predictability, and results, lasers are the future of cataract surgery.
