Laser Cataract Surgery

ts_120702_laser_eye_surgery_140x106In my book, Diabetic Eye Disease – Don’t Go Blind From Diabetes, I have a special chapter on cataract surgery, and I discuss that although everyone is likely to get cataracts, with diabetes, you are prone to getting cataracts at a younger ages than someone without diabetes.  Modern cataract surgery is an amazing procedure, where we dissolve the cataract inside the eye, and suck it out through a tiny incision, less than 3 mm in size.  Because it is so small, the incision is usually self-sealing, requiring no stitches, and so the recovery time is essentially 24 hours.

The major method we remove in the western world to remove cataracts through a small incision is called “phacoemulsification.”  Phaco means “lens,” and “emulsification” means to dissolve or emulsify.  The instrument that we use to dissolve the lens is a tip that vibrates at very high frequency (like 100 times faster than a bee’s wings).  It’s a great technology, but it is “mechanical,” which means it relies on vibration to break up the lens, and the vibration can effect other tissues inside the eye, especially if the cataract is very hard and we need to use a lot of vibration to break it up.  We use the fast vibrating energy ultrasound energy because the tip is vibrating faster than the vibration of sound waves — faster than 20,000 times per second.

So, along comes a new technology that has been developing in the past few years — laser cataract surgery.  There is a type of laser called the femtosecond laser which is proving useful in cataract surgery.  The femtosecond laser is used to place much more precise incisions than we are able to place with our regular incision techniques, and more direclty related to the cataract, it is used to break up and soften the cataract as preparation for the traditional phacoemulsification.  By fragmenting the cataract with with the laser, it allows the phacoemulsificaiton to go quicker.  This is especially useful for really hard cataracts as it then allows us to remove the cataract with less vibration energy.

At the American Society of Cataract and Refractive Surgery Symposium being held this week, several cataract surgeons reported on the benefits of using the femtosecond laser to assist with traditional phacoemulsification.  It sounds like there are definite advantages, but I’ll have to say, I think that it yet remains to be seen if those advantages will be significant in the real world.  After all, it’s not cheap to add this technology.  The femtosecond laser technology costs about $500,000 (yeah, that’s half-a-million dollars).  Add to that a maintenance contract of around $20,000 per year, and a usage fee of between $150-400 per eye, and you can see that it adds significantly to the cost of cataract surgery.

Time will tell if the technology is beneficial enough to be used routinely.  And with time, we can expect that the price of the technology will come down.  In any event, now when you hear “laser cataract surgery” you know what the issue is all about.  It’s used as a supplement to traditional phacoemulsification, not a replacement.

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