The advances in technology in the last 2 decades have been exponential. One need only look at the example of cellular phones to see the incredible progress that has been made in telecommunication over a short period of time. Medicine and in particular cataract surgery have also undergone similar changes. No one is surprised by the incredible advances in cataract technology, but what surprises many is that many surgeons are using the same technology now that was used 20 years ago, depriving their patients of the benefits of this remarkable procedure and the potentially better vision they could obtain.
Manual cataract surgery involves using a hand-held blade to make incisions in the front of the eye or cornea to correct astigmatism. A hand-held blade is also used to create the incisions into the eye necessary to remove the cataract and insert the intraocular lens (IOL). A circular opening in the capsule that contains the cataract is performed manually with a needle or forceps (called a capsulotomy), then ultrasound energy is used inside the eye to break up the cataract for it to be aspirated from the eye.
It should come as no surprise that the more precisely we can perform all of these steps, the safer and more precise your cataract surgery can be. Laser incisions placed in the cornea are more precise than those that can be produced with a hand held blade. It is impossible for the human hand, no matter how steady, to produce incisions to correct astigmatism that are consistently for example, 80% depth of the cornea, 30 degrees and at the precise distance from the center of the pupil needed to accurately correct astigmatism. The literature is abundantly clear that the laser performs much better than manual at correcting astigmatism in this way.
Studies by Bali et al, Roberts and Lawless [i], and a further study by the same authors (Journal of Cataract and Refractive Surgery 2015)[ii] have demonstrated that the capsulotomy created by the laser is more precise than what can be created by hand. The capsulotomy step is thought to be particularly important in visual outcomes. A precisely round, perfectly centered and properly sized capsulotomy is thought to influence the position of the lens implant or IOL in your eye. The more precise the placement of the IOL, the better your vision. One study compared manual capsulotomies to laser capsulotomies and showed that only 10% of the time manual capsulotomies were as good as laser, 90% of the time the laser performed this step more precisely. A study by Kranitz et al showed that the IOL was more precisely centered and fewer IOLs showed any degree of tilting inside the eye when this step was performed by the laser. Kranitz also showed that these patients had better vision 1 month and 1 year after surgery than the manual cataract surgery patients (Kinga Kranitz, Vol. 28, No. 4, 2012).[iii]
Laser cataract surgery involves the utilization of a sophisticated imaging system called Optical Coherence Tomography or OCT, which allows us to precisely map and image the eye undergoing surgery down to the fraction of a millimeter. This, combined with the precision of a laser allow us to perform cataract surgery (in my opinion and that of countless other eye surgeons) more precisely and safer than with a manual, hand-held blade
Laser cataract surgery allows cataract surgeons to fragment the lens so that it can be removed more safely and with less ultrasound energy and fluid flow through the eye than manual. Because the inside of the eye is so delicate, decreases in ultrasound energy and fluid flow through the eye lead to better outcomes as demonstrated by studies by DeLaCruz, Mastropasqua, and Mayer.
What really matters is improved vision. Separate studies by DeLaCruz, Filkorn (Tamas Filkorn, MD, Illes Kovacs, MD, PhD, Agnes Takacs, MD, Eva Horvath, MD, Michael C. Knorz, MD, Zoltan Z. Nagy, MD, DSC, Vol. 28, No. 8, 2012)[iv], and Kranitz (Kinga Kranitz, Vol. 28, No. 4, 2012)[v] all showed improved vision with Laser cataract surgery as compared to manual cataract surgery.
Roberts and Lawless in The Journal of Cataract and Refractive Surgeon (2015) (Timothy V. Roberts, MB BS, MMed, FRANZCO, FRACS, Michael Lawless, MB BS, FRANZCO, FRACS, Gerard Sutton, MB BS, MD, FRANZCO, FRACS, Chris Hodge, BAppSc, 2015), showed improved outcomes, better vision, and fewer complications in 2621 eyes.
There is a growing body of literature in peer-reviewed journals indicating that Laser cataract surgery may be better than manual cataract surgery.
Since performing the first Laser Cataract Surgery in Southwest Florida in May of 2012, I have performed thousands of these procedures. The company that makes the laser that has the lion’s share of the laser cataract surgery market (LenSx/Alcon) tells me that I am one of the top 5 Laser Cataract surgeons in the country. I’m proud that we have been able to bring such incredible sight saving technology to our area to benefit you, our patients.
Thanks for the honor of allowing me and our team to take care of you.
[i] Timothy V. Roberts, MBBS, MMed, Michael Lawless, MBBS, FRANZCO, Shveta J. Bali, MBBS, MD, Chris Hodge, BAppSc(Orth), Gerard Sutton, MBBS, MD. (2013). Surgical Outcomes and Safety of Femtosecond Laser Cataract Surgery: A Prospective Study of 1500 Consecutive Cases. American Academy of Ophthalmology, 227-233.
[ii] Timothy V. Roberts, MB BS, MMed, FRANZCO, FRACS, Michael Lawless, MB BS, FRANZCO, FRACS, Gerard Sutton, MB BS, MD, FRANZCO, FRACS, Chris Hodge, BAppSc. (2015). Anterior Capsule Integrity after femtosecond laser-assisted cataract surgery. Retrieved from Journal of Cataract and Refractive Surgery: http://dx.doi.org/10.1016/j.jcrs.2014.11.044
[iii] Tamas Filkorn, MD, Illes Kovacs, MD, PhD, Agnes Takacs, MD, Eva Horvath, MD, Michael C. Knorz, MD, Zoltan Z. Nagy, MD, DSC. (Vol. 28, No. 8, 2012). Comparison of IOL power calculation and refractive outcome after laser refractive cataract surgery with a femtosecond laser versus conventional phacoemulsification. Journal of Refractive Surgery, 540-544.
[iv] Leonard Mastropasqua, MD, Lisa Toto, MD, PhD, Alessandra Mastropasqua, MD, Luca Vecchiarino, MD, Rodolfo Mastropasqua, MD, Emilio Pedrotti, MD, Marta Di Nicola, PhD. (Vol. 30, No. 1, 2014). Femtosecond laser versus manual clear corneal incision in cataract surgery. Journal of Refractive Surgery, 27-33.