The New Frontier in Cataract Surgery
At this time there are approximately 100 lasers in the United States that have been purchased to assist in cataract surgery. It is still early in the development and use of lasers in cataract surgery. The benefits of using the laser during cataract surgery are not fully known at this time.
What is a Laser?
A laser is a focused beam of light of a single wavelength. Different wavelengths have different properties such as some produce heat when applied and others are cold lasers that do not produce heat when applied. The action of the laser can also be adjusted by changing different parameters of the laser;
Power settings of the laser
Duration of the laser application
Size or diameter of the laser beam
Femtosecond lasers are used during cataract surgery. A femtosecond laser uses laser pulses of one millionth of a nanosecond duration.
What is the Laser Used for During Cataract Surgery?
The femtosecond laser is a precise cold cutting laser that accurately cuts tissue that is controlled by a computer. A high resolution imaging device is connected to the laser and computer system to analyze the eye and determine where the laser applications will be applied. The laser is able to perform several steps of the surgery and include;
Making the incisions that are used for instruments to enter the eye
Incisions on the cornea to correct astigmatism called limbal relaxing incisions or LRI
Performing the capsulorhexis or circular opening in the anterior capsule (human lens is surrounded by a thin capsule)
Laser applications are applied to the nucleus of the lens to soften the nucleus for easier removal
The laser does not remove the lens or cataract. It is able to perform these four steps in the process of performing cataract surgery. Ultrasound is used to dissolve the nucleus of the lens and the lens material is aspirated from the eye.
Primary and Side Incisions in the Cornea
There are usually 2 incisions made through the cornea (clear portion of the eye) near the sclera (white portion of the eye). The incisions are usually made with a metal, diamond, or ruby blade. These incisions are very easy to perform. The laser can make these slightly more precisely.
Correcting Astigmatism with Limbal Relaxing or LRI Incisions During the Cataract Procedure
If the cornea shaped like a football versus a basketball cut in half, a person has astigmatism and will see blurred without glasses after cataract surgery. The femtosecond laser is able make an incision on the steep side of the cornea to correct the football shape of the eye. If a person wishes to see better without glasses, they need to have their astigmatism corrected.
A capsulorhexis is a circular opening made in the anterior or front portion of the capsule that surrounds the lens. The femtosecond laser can precisely make this opening in the capsule. This is one of the most delicate steps during cataract surgery.
Softening of the Nucleus with the Femtosecond Laser
The femtosecond laser application can be applied to the nucleus a variety of patterns that can be chosen by the eye surgeon. This softening of the nucleus means that less ultrasound power will be needed to remove the lens.
Femtosecond Laser Systems for Cataract Surgery
Technolas by Bausch and Lomb
iFS by Abbott Medical Optics
Catalys by OptiMedica
These lasers have received FDA approval for a variety of the different steps listed above.
Routine cataract surgery is very successful without the use of a femtosecond laser. The potential benefits of laser cataract are still not fully known or studied. Doctors cannot charge for the use of the laser during regular cataract surgery as the current code includes doing cataract surgery by any method. Doctors can charge for the correcting the astigmatism and can charge fees over Medicare allowable with upgrades of premium intraocular lenses.