Lasers play a major role in the management of a number of ocular disorders, but until now cataract surgery has always been performed using traditional surgical instruments, relying on the skill of the surgeon to make precise incisions.
Many patients assume that cataract surgery is already undertaken using a laser. This is entirely understandable as patients are aware of the ultra-precision offered by surgical techniques using a laser e.g. LASIK for the treatment of myopia. This has not been the case for cataract surgery until very recently. However, Laser Cataract Surgery, and Laser Clear Lens Surgery, are now very much a reality.
At the Face & Eye Clinic in South Manchester, we are amongst the first ophthalmic surgeons in the UK, as well as the rest of the world, to be able to offer the most advanced form of cataract surgery, or clear lens replacement surgery (for the management of optical errors which are not suitable for standard corneal laser correction). Laser Cataract Surgery offers safer, quicker and improved visual outcomes by eliminating the potential for human error in performing certain delicate parts of the procedure that may lead to complications and loss of optimum visual function.
The femtosecond laser
In the UK, since the mid-1990s, phacoemulsification cataract surgery (using a small ultrasonic probe introduced into the eye through a small incision) has been the gold standard both for cataract surgery and clear lens surgery.
The current surgical techniques require a blade to create the corneal incisions and either small forceps or a bent needle tip to create the circular opening in the membrane (or capsule) at the front of the cataract or lens (a procedure referred to as an anterior capsulorrhexis).
The need for these manual techniques can now be eliminated by using the far more accurate Femtosecond laser. The capsulorrhexis, which is crucial to the success of the operation, can be made to the desired dimension in a perfect circle. The Femtosecond laser can also be used to make precise additional relaxing corneal incisions in order to reduce astigmatism and further improve the optical result.
As a result, with the aid of our specialised Femtosecond Laser, it is now finally possible to carry out Bladeless Laser Cataract Surgery.
There are 4 main areas of cataract surgery which are enhanced by the use of the femtosecond laser:
The corneal incision
The laser creates a very precise incision through which instruments can be inserted into the eye to remove the cataract with a water tight seal.
- No sutures (stitches) are required as the incision closes by itself at the end of the operation
- No suture (stitch)-related astigmatism or infection
- A much reduced risk of a postoperative wound leak which can predispose to postoperative infection and which may require further surgery
- Bladeless surgery
Using the Femtosecond laser to create the capsulorrhexis (the opening in the front lens membrane or anterior lens capsule) results in a circular opening of exactly the required size and in precisely the correct position. This step is one of the most critical and delicate parts of any modern cataract operation.
The Femtosecond laser makes this surgical step much more predictable. The precise size and centration of the capsulorrhexis (the opening in the anterior lens capsule) allows for a more stable, better centred intraocular lens, which in turn is less likely to tilt or shift. This is important in ensuring the best possible optical outcome and is even more crucial to the optical outcome when using premium advanced technology lenses such as Multifocal or Toric lens implants.
- Capsulorrhexis construction is the most delicate and crucial step for the safety and outcome of the operation
- The femtosecond laser makes this step very precise and reproducible
- A capsulorrhexis of the correct size allows an easier removal of the cataract or clear lens
- A capsulorrhexis of the correct size and shape reduces the risk of the intraocular lens tilting or becoming decentred
- A precise capsulorrhexis aids better lens positioning and therefore more predictable visual outcomes
- A precise capsulorrhexis reduces the risk of the capsule of the lens tearing and therefore of further more invasive surgery.
Corneal relaxing incisions
The laser can make very precise additional incisions in the cornea if required
- Reduction in astigmatism
- Reduced need for glasses after surgery for astigmatism
- Improved visual outcomes
Fragmenting the cataract/clear lens
Fragmentation of the cataract or clear lens into small pieces is important to help remove the cataract from the eye using ultrasound energy. The adult lens is approximately 10mm in length and 4 mm in thickness.
As the incision made in the cornea for removal of the cataract lens is usually less than 3mm. Clearly the cataractous lens will have to be broken down to aid removal. The femtosecond laser performs this part of the surgery precisely to allow an easier and faster removal of the cataract or clear lens.
- The cataract is in a bag held in place by delicate fibres within the eye called zonules. These are less likely to be damaged during the removal of the cataract or clear lens and will allow the new lens implant to be more stable in the eye.
- Less ultrasound power is used within the eye reducing the risk of damage to the cornea and reducing postoperative inflammation.
Overall using the femtosecond laser to perform cataract surgery or clear lens surgery offers greater precision, greater safety and improved visual outcomes.
Doesn't All Cataract Surgery Involve a Laser?
This is a common misconception. Until now, a laser has only been used to treat a thickened membrane situated just behind the intraocular lens (or lens implant) some months or years after cataract surgery. This is referred to as a YAG laser capsulotomy. For the last 2 decades Phacoemulsification surgery (using a small ultrasonic probe introduced into the eye through a small incision) has been the gold standard in cataract surgery ..... until now.
Can Everyone Have Laser Cataract Surgery?
The vast majority of patients can have surgery using a laser. However, patients with pre-existing corneal scarring, or poorly dilating pupils, for example, may not be suitable for Laser Cataract Surgery. For these patients, however, we can offer other advanced surgical techniques.
Will Laser Cataract Surgery correct Astigmatism, Myopia (short-sightedness) or Hypermetropia (long-sightedness)?
Cataract surgery itself is a refractive procedure and the new technology can assist in correcting Astigmatism, Myopia and Hypermetropia, especially if combined with the appropriate lens implant.
Which patients will benefit most from Laser Cataract Surgery?
Potentially every patient may benefit from Laser Cataract Surgery, regardless of the type of cataract. An even greater benefit may, however, be seen in some patients with corneal problems, such as Fuchs' Endothelial Dystrophy, and patients with certain types of glaucoma.
Are surgical blades or knives still required?
As the femtosecond laser makes all the required incisions the procedure is essentially "bladeless".
Is Laser Cataract Surgery Quicker?
The use of a Femtosecond laser does indeed speed up steps in a cataract operation. More importantly, however, the use of the Femtosecond laser results in a safer, more precise and more predictable operation.
Can This Technique Be Applied to Clear Lens Surgery or PRELEX (Presbyopic Lens Exchange to remove the need for reading glasses)?
Femtosecond laser surgery is ideally suited to these types of surgical procedure. Clear Lens Surgery and PRELEX both demand a greater level of predictability and accuracy in order to achieve the best optical outcomes.
What About The Risks? Isn't New Technology Like This More Risky?
Whilst Laser Cataract Surgery is a new innovation, it uses a laser technology (Femtosecond laser) that has proven itself to be safe and reliable when used in ocular surgery, such as laser vision correction, since 2001. As with all forms of surgery, there are small risks but Femtosecond laser technology makes cataract surgery an even safer and more predictable operation than before.
Does Laser Cataract Surgery Cost More?
This technique utilises the latest in Femtosecond laser technology. There is, therefore, a moderate increase in the cost of the surgery, associated with the provision of this new sophisticated technology.
I have private medical insurance. Will my insurance company pay for the procedure?
Cataract surgery is covered by most medical insurance companies. However, the extra costs of the laser are not currently covered and this will therefore require an additional payment by the patient.
How soon after my laser cataract surgery can I .....?
Click here for a downloadable PDF giving details of what you can do and when you can do it, following your surgery.
Please note that although cataract surgery can be performed under local anaesthesia alone, local anaesthesia with safe, conscious intravenous sedation given by a very experienced and skilled consultant anaesthetist (commonly referred to as “twilight anaesthesia”) is also available where requested. This form of anaesthesia is extremely popular with our patients and the effects are reversed very quickly. It enables local anaesthetic injections to be given painlessly with little recollection of the surgery, and helps to keep patients calm, relaxed and comfortable.
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What our patients say
“...the level of your counselling and understanding of my concerns, also your surgical skills, culminating with successful cataract surgery and lens implant...has more than surpassed my expectations.” Read John's letter