Cataracts affect millions of Americans each year, and as the leading cause of vision loss in people over the age of fifty, it’s no wonder new advances in cataract surgery are breaking through on a regular basis. The most recent development? Laser technology—the new-and-improved version of the traditional hand-and-knife technique of past decades. With laser surgery comes the benefit of a bladeless procedure and the use of a highly customized eye map for greater accuracy.
What Is a Cataract?
A cataract is the thickening of the eye’s lens. Overtime, this “clouding” begins to restrict the light flow to the retina, causing eyesight to become blurred and dim, with the visual acuity similar to someone looking through a foggy window. Eventually, if no action is taken, total vision loss will occur. Though this condition is chronic and arguably inevitable, cataract surgery is a safe and effective solution, with a 98% success rate of improved vision in patients.
Traditional Cataract Surgery
Originally, the procedure to remove a cataract involved using a diamond blade to make a small incision in the cornea, the clear outer coating of the eye. The surgeon would then insert a small, ultrasound wave-emitting probe to soften the cataract enough to be suctioned out of the cornea. Once the cataract was cleared, only the thin outer membrane of the cornea—the lens capsule—remained. An intraocular lens (IOL) would be inserted onto the lens capsule, allowing light to once again safely pass through to the retina. (Note: Though laser technology is gaining widespread acceptance, traditional cataract surgery is still a common and modern procedure.)
Laser Cataract Surgery
Out with the Old
While some of the actual cataract removal process remains the same, replacing traditional incision instruments with a laser has quite a few benefits. Laser technology allows for increased accuracy when it comes to creating the initial incision and circular opening through which the cataract will be removed. Through an optical coherence tomography, a 3D image of the eye is captured, enabling the laser to incise at the correct points on the cornea, creating openings at precisely the correct depth and length. This precision also allows for a greater degree of success when the cornea self-heals after surgery.
In with the New
Next, the front portion of the capsule lens is removed. This “anterior capsulotomy” is performed with a femtosecond laser and gives access to the cataract while creating a space for the new lens to be planted in its place. A laser is then used to break down the cataract itself, which is a gentler process requiring less ultrasound energy and a decreased chance of burning, distortion or an acquired astigmatism. As with traditional cataract surgery, the cataract is removed with the probe and an IOL is inserted on the lens capsule.
As with any major surgery, meticulous planning must be done beforehand. Using the 3-D image technology, your surgeon will create a detailed map of your eye to assess thickness of the cornea and depth of the anterior chamber, the fluid-filled space between the cornea and the lens. He or she will also measure pupil diameter and determine parameters for the incisions made during the procedure. On the day of surgery, you will remain awake, but your eye area will be numbed and your eye will be stabilized in a laser platform.
During the 15- to 20-minute procedure, your surgeon will use the information gathered from the 3D images and maps to obtain greater accuracy and precision. The procedure itself is not painful, but you may experience slight tugging or pressure. You will be sedated for relaxation and lying under bright lights so you will not feel any discomfort or witness any of the procedure.
Laser cataract surgery is an outpatient procedure, which means that you will be able to go home the same day. Once vitals are normal, most patients can leave within an hour after the surgery is completed. You will most likely feel slight discomfort, itching, and blurred vision for a few days while your eye heals. Resist the temptation to rub your eyes, lift heavy objects, or perform any other strenuous tasks. Follow-ups are usually scheduled within a few days and over the next few months to ensure the eye is healing properly and no complications have arisen.
The cost of laser cataract surgery varies based on specific eye-correction options and insurance plan coverage. Even if a portion of the surgery is covered, there may be additional out-of-pocket deducibles or copayments that will need to be met. With so many variables, it is best if you consult with our office and your insurance company to determine cost and benefits specific to you.
Risk and Complications
Most post-surgery complications are low-risk and easily treatable. If a complication does arise, it is most commonly a posterior capsule opacification (PCO), or the slight thickening of the lens capsule due to a regrowth of the cells. This is not a new cataract; cataracts do not grow back. However, this thickening can cause slight blurriness and sensitivity to bright lights. This complication can be corrected with a Nd:YAG laser capsulotomy, where the surgeon uses a laser to make a small hole in the back of the lens, allowing light to pass through to the retina. PCO is relatively uncommon, affecting only about 20% of laser cataract surgery patients.
Is Laser Cataract Surgery Right for Me?
Begin by scheduling a consultation with Drs. Miller & Shilman. During this appointment, they will assess your eye structure, the condition of your cataract, and if you have any interfering medications or health concerns. Remember, cataract surgery is currently the most common and safest surgery performed each year, but if you have additional concerns regarding the procedure, please call our office.