The future of cataract surgery is here!
Femtosecond Laser cataract surgery is the latest development in cataract surgery. It is not just an evolution but rather a revolution. This new technology has taken the ophthalmic world by storm and is rapidly replacing the current techniques of cataract surgery. In barely more than a year it has gone from being a concept to reality and is now becoming available in Australia.
WHAT IS FEMTOSECOND LASER CATARACT SURGERY
In a conventional cataract operation, a surgeon performs the entire procedure by hand. The entry ports, the wounds, the opening of the lens capsule and the removal of the lens are all done by hand. The opening of the lens capsule in particular involves tearing a round hole in the anterior lens capsule by hand. This is akin to taking a piece of paper and tearing a round hole in it.
Femtosecond Laser cataract surgery does all of this with a computer guided laser. The surgeon instead controls the operation with a keyboard and monitor. In essence, it is robotic surgery.
WHY EVERYONE SHOULD HAVE IT
As key parts of the procedure are now NOT done by human hands, there is less to go wrong therefore surgery is much safer.
Furthermore the steps are now precise and reproducible so these steps are now perfect every time. One of the biggest difficulties in cataract surgery is the unpredictability of the refractive results (the final script and therefore what glasses are needed after surgery). At present, if we want to leave our patients with no glasses for distance after surgery, we can only be confident that we will achieve it 75% of the time. Although the remaining 25% may come close, there are some that end up considerably out from ourtarget and therefore still unable to see without glasses. Laser cataract surgery promises to improve the odds of getting closer to our goal.
BETTER ASTIGMATISM CONTROL
The wound creation is now precise and reproducible. This is very important as the wound has a major role in how much astigmatism is left after surgery. Sometimes the wound causes rather than reduces astigmatism. Precise reproducible wounds should therefore translate into more predictable astigmatic outcomes.
BETTER IMPLANT POSITION
A key factor in reproducible and accurate surgery is the final position of the implant.This is referred to as the Effective Lens Position.The implant(lens) needs to be precisely the correct distance from the retina so that the image is formed at its focal point. This is highly dependent on having an accurate, round opening in the capsule which is of the correct size. With laser cataract surgery this will now happen every time.
CATARACT REMOVAL AND IMPLANT INSERTION
The cataract is normally removed by a hand held probe (phaco handpiece). This probe uses ultrasound energy to break up the lens. This will now be done by the laser. The actual removal of the broken up lens and the insertion of the implant is still however done by hand.
CAPSULAR OPACIFICATION (SECONDARY CATARACT)
On of the problems with cataract surgery is the development of posterior capsular opacification (PCO). This can occur in a percentage of patients months to years after the surgery. This is the formation of opacities on the back surface of the capsule that is holding the implant in place. It results in a drop in vision. It is known that a key factor in preventing it is having a complete overlap of the front surface of the lens by the hole in the anterior capsule (the capsulorhexis). With a hand torn opening this can be a bit hit and miss but with a laser created opening it will be perfect very time. Although PCO is easily managed, minimizing is of course preferable
THE FINAL OUTCOME
The results of laser cataract surgery should therefore be safer and more precise than ever but one needs to bear in mind that at the end of the day it is still surgery on a human being therefore there are never any guarantees. The expectation is that complications should be less, but there will still always be complications and less than ideal outcomes.