Laser Cataract Surgery

Before Lasik, the thought of replacing a scalpel with a laser sounded a bit like replacing the Count of Monte Cristo’s sword with Luke Skywalker’s light saber.

Now laser eye surgery is such a familiar idea, some patients are surprised to learn that using lasers for cataract surgery is recent news. However, for the right patient, that news is good news, especially for those who have both cataracts and astigmatism.

“Our LenSx® femtosecond laser also allows us to correct some astigmatism so the patient’s vision after the cataract surgery is crisper,” UAB ophthalmologist Virginia Lolley, MD, said. “In some cases, there is enough improvement that patients who prefer multifocal lenses may have that option.”

Another advantage is that treating the cataract with laser before surgery presoftens it and allows the surgeon to use less ultrasound energy to break up and remove the cataract, which can be particularly helpful when the cataract is denser than usual.

“We can watch the lens on the monitor and see it softening. Using the LenSx to make incisions is also very precise.  It gives us a high degree of accuracy,” Lolley said. “LenSx has built-in mapping so we can measure the topography of the eye in advance, and use image guidance during the procedure. It only takes a short time to do the laser treatment, then we’re ready to move on to remove the cataract and place the lens.

“I like using the laser because it allows better results. LenSx is also customizable and programmable. Every patient is different, and this helps us adapt the procedure to each patient’s individual requirements.”

Lolley cautions that laser cataract surgery isn’t for every patient.

“Glaucoma and previous Lasik surgery are contraindications,” she said. “It also isn’t covered by Medicare and many health plans, so there are usually additional out-of-pocket costs for the patient.  However, those who are likely to benefit often consider it a good investment. The feedback we’ve received has been very positive.”

To qualify to use the LenSx in cataract procedures, eye surgeons must have prior expertise in cataract surgery, and complete a training course before performing ten procedures under supervision. At present, the FDA has approved using LenSx in cataract surgery only in cases of astigmatism or when a premium lens is being implanted. In those cases, available evidence supports better outcomes. Data is currently being gathered to determine whether better outcomes are also likely for other patients.

 “So far, I’ve been very pleased with using the laser in cataract surgery,” Lolley said. “We’ve seen no problems and patients have been very happy with the results.”