What Does Bladeless Laser Cataract Surgery Mean?
Many eye doctors are advertising and using the term bladeless laser cataract surgery. When people see or hear about this, they think that the laser magically dissolves or removes the cataract from the eye. It is just like on Star Trek where people where vaporized. The laser used in bladeless laser cataract surgery does not actually remove the cataract. The laser performs several of the steps in performing cataract surgery. The actual bladeless portion is probably the least important step of the surgery. The laser is able to make the incisions in the eye, perform the capsulorhexis, and divide and/or soften the lens inside the eye.
What is a Cataract?
Most people think that a cataract is a film or growth that grows over or covers the eye. A cataract is the lens that is located behind the pupil becomes hazy or cloudy. The term cataract comes from the word used for rapids or falls in a river. The water turns from clear to white as the water is churned through the rapids, falls, or cataract. If the cataract progresses to the point of becoming ripe, the pupil turns white. This is where the term originated. The pupil would become white like the cataract or rapids in a river. Most people do not wait until the cataract becomes ripe or white in the United States. The vision with a ripe cataract is very poor such as only being able to see hand movement at one foot in front of the eye. You would be blind. Ripe cataracts are common in third world countries where there is limited access to cataract surgery.
What is a Femtosecond Laser?
First we will describe what a laser is. A laser is a single focused wavelength of light. Different wavelengths have different properties. Some wavelengths produce heat and burn whatever they are aimed at. Other laser wavelengths are what we call cold lasers. They cut or disrupt structures without producing any heat. A femtosecond laser precisely cuts or disrupts tissue cleanly without producing heat which would damage surrounding tissue. A femtosecond laser has a wavelength of 1053nm. The femtosecond laser has a pulse duration of 10̄ ̄ᶦ⁵. That is a lot of zeros which means it is an extremely short duration. The laser works by photodisruption or photoionization of tissue such in the cornea or lens. The laser produces an area of free electrons and ionized molecules just like you saw on Star Trek where they said Scotty beam me up or they vaporized some alien. These lasers are very precise and are able to perform several micro steps of the cataract surgery procedure. These types of lasers are also used in forming the corneal flap in LASIK surgery. There are several companies that make femtosecond lasers for cataract surgery.
- LenSx (Alcon Laboratories)
- Victus (Baush and Lomb)
- Lensar (Lensar Inc)
- Catalys (AMO)
- Femto LDV Z8 (Ziemer Ophthalmic Systems)
Femto Second Laser Cataract Surgery or Laser Surgery for Cataract
The Femto second laser performs several steps in the cataract surgery procedure. It forms the two incisions used during cataract. These incisions are very small with the larger incision typically 2.2 mm wide. The lens inside the eye is surrounded by a very thin capsule which is like Saran wrap in thinness. This procedure is called a capsulorhexis. The laser makes an extremely fine perfectly circular cut on the anterior surface of the capsule. The size of the opening can be programmed by the surgeon. The femtosecond laser can also be used for astigmatism correction. The laser can make a relaxing incision on the cornea to change the shape of the cornea. Astigmatism is caused by the cornea being shaped more like a football cut in half length wise versus a basketball. A football shaped eye will focus light to a line inside the eye where a basketball shaped eye will focus light to a fine clear point in the eye. The next step performed by the femtosecond laser is the cataract or cloudy lens material is divided into quadrants. The lens can also be softened by the laser to facilitate the removal of the cloudy lens material. Once the lens has been treated, it makes it easier for the ultrasound probe to emulsify and remove the cataract from the eye. Many people ask how long does cataract surgery take. Some eye surgeons are faster than others but ten minutes is a good average.
The femtosecond laser docking connection is placed on the front surface on the eye and is attached to the eye by suction. This keeps the eye still and stable while the laser is performing its steps of the procedure. The patient may feel a mild pressure sensation but the procedure is otherwise pain free. The femtosecond laser completes its steps in twenty five seconds or so.
Sometimes the capsule that is left to hold the intraocular lens in place after cataract surgery can become cloudy which is called posterior capsular opacification. This can be lasered open by a similar laser called a Yag laser.
What to Expect After Cataract Surgery?
Prior to cataract surgery, the pupil is dilated so that the surgeon has access to the lens or cataract behind the pupil. This dilation can last the whole day or sometimes even into the next day. This may cause some blurred vision until the pupil returns to normal. The light from the microscope is bright and will decrease the vision for a time. The surgical procedure itself will keep you from seeing well immediately. Cataract recovery time is that typically the person will have good vision by the time they wake up the next morning. It may take up to three weeks or so for maximum return of vision. You will be using eye medications for about three weeks after the surgery. Many eye doctors start you on an antibiotic drop two or three days prior to surgery.
What are the Advantages of Femtosecond Laser Cataract Surgery?
Many studies have shown that using a femtosecond laser decreases the ultrasound or phacoemulsification time. This reduces the length of surgery and damage to the corneal endothelium. The ability of the femtosecond laser to perform a precise capsulorhexis is important. Having the capsulorhexis centered each time and the size always being consistent provides a stable or consistent effective lens plane. Effective lens plane means that the intraocular lens sits in the same relative position inside the eye. This means that the patient’s visual outcome becomes more consistent. The post-operative refractive error will be less. The laser can correct the astigmatism which will also decrease the need for wearing glasses. The femtosecond laser provides a safer procedure and less dependence on glasses.