Femtosecond Laser Cataract Surgery

The laser can by used to perform the following steps of the cataract surgery:

• The laser can create the opening in the capsular bag (the capsulotomy) in a more precise manner. The eye’s natural lens is surrounded by a very thin, clear capsule. In cataract surgery, the front portion of the capsule is removed in a step called an anterior capsulotomy. This enable the surgeon to gain direct access to the cloudy lens (cataract). It’s very important that the remainder of the lens capsule that remains intact in the eye is not damaged during cataract surgery, because it must hold the artificial lens implant in place for the rest of the patient’s life. In traditional cataract surgery, the surgeon creates an opening in the capsule with a small needle and then uses that same needle or a forceps to tear the capsule in a circular fashion. In laser cataract surgery, the anterior capsulotomy is performed with a femtosecond laser instead. This is especially important when implanting a toric or multifocal (presbyopia-correcting intraocular lenses), as it helps with the positioning of the lens implanted itself. There is evidence that femtosecond assisted cataract surgery can improve patient outcomes with presbyopia correcting IOLs. The laser capsulotomy affects ultimate lens position and the way the capsular bag shrinks around the IOL, which is size and centration dependent. Having a well-centered, standardized capsulotomy provides a more reliable outcome. Additionally, the laser cataract surgery may also reduce the risk of capsule breakage that can cause vision problems after surgery. The lens capsule is as thin as film and it’s important that the portion that is left inside the eye after cataract surgery is undamaged, so it can hold the IOL in the proper position for clear, undistorted vision.

• The lens is used to fragment, or soften the lens, thus requiring less phacoemulsification ultrasound energy to break up the lens in the eye, resulting in less potential damage to the cornea. In traditional cataract surgery, the ultrasonic device that breaks up the cataract is inserted into the incision. During this phacoemulsificatin procedure, the ultrasound energy can lead to heat build up in the incision, which sometimes can burn the incision and negatively affect the visual outcome by actually inducing astigmatism. The laser, on the other hand, softens the cataract as it breaks it up. By breaking up the cataract into smaller, softer pieces, less energy should be needed to remove the cataract, so there should be less chance of burning and distorting the incision.

• The laser is used for correcting astigmatism. In patients with corneal astigmatism, the laser can be used to make incisions in the cornea that may reduce or eliminate the astigmatism, thus decreasing the reliance on glasses or contacts. To reduce the need for prescription eyeglasses ore reading after cataract surgery, it is important that little or no astigmatism is present after implantation of presbyopia-correcting multifocal IOLs and accommodating IOLs. Astigmatism usually is caused by the cornea being more curved in one meridian than others. (In other words, it’s shaped somewhat like a rugby ball rather than a football). To reduce astigmatism, small incisions can be placed in the periphery of the more curved meridian; as the incisions heal, this meridian flattens slightly to give the cornea a rounder, more symmetrical shape. This procedure is called limbal relaxing incisions (LRI). During refractive laser-assisted cataract surgery, the OCT image can be used to plan laser LRIs in a very precise location, length and depth. This increases the accuracy of the astigmatism-reducing procedure and the probability of good vision without glasses after cataract surgery. In patients who do not have enough astigmatism to require a toric intraocular lens but enough that they will still require glasses or contacts, the femtosecond lens is a great option to eliminate the astigmatism. There is evidence that femtosecond laser assisted cataract surgery can predictably manage astigmatism for patients electing this correction at the time of cataract surgery, with great precision and predictability.