The terms “bladeless” and “laser” have caused quite a stir in the field of medical technology recently. Doctors now employ laser technology in fields as diverse as vascular surgery, podiatry, gastroenterology and, most widely known, in vision-correcting surgeries such as LASIK. It is hard to overstate the benefit of laser technology in these realms; many laser techniques are minimally invasive and offer a quicker recovery and sometimes a better result than traditional methods. Patients therefore are understandably attracted to the lure of “laser” and “bladeless” techniques whenever they become available. Naturally then, when laser-assisted cataract surgery became available recently, it instantly caught the attention of patients and practitioners alike. Some patients even were willing to pay an extra one to three thousand dollars per eye for this new technology, as this version of cataract surgery is not covered by insurance.
Since Tarantino Eye Center opened its doors fifteen years ago, our physicians have performed thousands of successful cataract extractions. Thanks to cutting-edge research and developing technologies, the way in which we perform cataract surgery has become an incredibly refined and effective procedure, and patients are very satisfied with their visual outcome. But before we embrace any new technology (especially one as costly as the femtosecond laser), we must have proof that it offers our patients some significant benefit, be it increased safety, a shorter recovery, or a better visual outcome, over other established techniques. So far, there is little to no evidence to suggest that laser-assisted cataract surgery fulfills any of these requirements. We’ve chosen to use this space to inform our patients, and the wider community, of how this method differs from the standard method, and if it is worth its price tag.
How does laser-assisted surgery differ from other contemporary methods?
Keep in mind that laser-assisted cataract surgery is just that, laser assisted. No one can completely remove a cataract with a laser, and the majority of the procedure is the same for both techniques.
Entering the Eye
The first step of cataract surgery, after preparation and anesthesia, is to enter to eye in order to retrieve the cataract (the cloudy lens inside the eye). In both procedures, this is done via a tiny incision made on the edge of the cornea (the clear outer covering on the front of the eye). Most surgeons make the incision manually with a precision blade. This under three millimeter incision is cut in such a way that is self-sealing and rarely requires sutures. In laser-assisted cataract surgery however, the laser, called the femtosecond laser, makes this same incision for the surgeon.
There have been claims that the laser is able to cut more precisely and accurately than a metal blade, but, for all but the least experienced surgeons, the precision and accuracy of the incision is a nonissue. The vast majority of cataract surgeons are very comfortable making this incision and the complications due to errors in creating the incision are low–practically nonexistent for most surgeons. As of now, we do not have sufficient evidence to support the claim that a laser incision is safer than a manual incision, especially when performed by an experienced surgeon.
Extracting the Cataract and Inserting the Lens Implant
After the initial incision, the laser-assisted and standard methods do not differ much at all. Though the laser can be used to open the cataract’s front covering and partially break it up, the majority of the lens extraction is exactly the same in both methods. In both types of surgery, the cataract must be broken up with an ultrasound and then extracted using suction. Afterwards, an artificial lens, called an intraocular implant, is then inserted into the eye to replace the natural lens’ focusing power. These two steps (i.e., the bulk of the surgery) are completed the same way for both methods of cataract surgery.
Does the laser-assisted method offer patients a better outcome?
Since the two methods are so similar, it is reasonable to assume that the outcomes for each are also similar. There again haven’t been any extensive, peer-reviewed studies to support the claim that laser-assisted surgery leaves patients with better outcomes than their counterparts who had traditional surgery. Complication rates are similar for both methods of cataract surgery and, in the early stages of implementation, they may even be higher with the laser, as it takes time for surgeons to master new techniques. Most patients experience significant visual improvement after both kinds of cataract surgery, and this improvement is due not to the use of the laser, but to surgeon skill, correct calculation of the lens implant power, and the patient’s underlying eye health.
Can the femtosecond laser leave patients free from glasses?
Sometimes, but so can standard cataract surgery. In most cases, whether or not the patient needs glasses after surgery is based on the lens implant, and the same types of lenses are used in both types of surgery. A patient and their doctor must choose the most appropriate lens.
The standard lens– This lens is covered completely by health insurance. Depending on the patient’s desires, it can leave patients less dependent on glasses in the distance or at near (but not both), especially if they do not have astigmatism.
The multifocal lens– This lens isn’t covered by insurance and usually costs around $2,500 per eye. It can leave patients mostly free from both reading and distance glasses. This lens is not available for patients with astigmatism.
The toric lens– This lens also isn’t covered by insurances and costs the patient about $1,200 per eye. It corrects astigmatism and can leave patients less dependent on glasses in the distance or at near-but not both. Some patients then may end up hardly needing glasses at all if they choose the multifocal lens, but for patients with astigmatism, this lens is not an option. That’s where the femtosecond may be useful. During the surgery, the femtosecond laser can be used to correct the patient’s astigmatism, and then a multifocal lens can be inserted, leaving the patient generally spectacle-free. So for patients with astigmatism who don’t want to use glasses at all, laser-assisted surgery may be a great option. Patients should be aware, however, that toric multifocal lenses are now being used in Europe, and are expected to be available in the United States in the near future. This would also allow patients with astigmatism to be generally free from glasses without using the femtosecond laser at all.
Is laser-assisted cataract surgery worth $1,000-$3,000 per eye? So far the answer is “probably not.” While many patients are persuaded by the terms “laser” and “bladeless,” we warn patients to not automatically assume that they need to pay extra for laser-assisted surgery to experience a good outcome. Cataract surgery is refined, precise and extremely satisfying for the vast majority of patients. If you are under the care of a well-trained surgeon, you should feel confident that either technique you choose is a good choice for your eye health.
The femtosecond laser may hold promise for the future, but we just aren’t sure yet. We, like most cataract surgeons, will carefully watch for scientific evidence that laser offers some benefit over standard surgery. If peer-reviewed evidence to suggest that laser is advantageous becomes available, we will look to adopt the laser method so that we may offer our patients the most beneficial technologies. For now, we will regard laser-assisted cataract surgery with guarded optimism, and we recommend that the community do the same.
The Bottom Line:
- Laser-assisted cataract surgery and standard cataract surgery have much in common; most of the procedure is exactly the same in both methods, as it is impossible to remove a cataract with a laser.
- Laser-assisted cataract surgery has not been shown to give faster recovery or better outcomes than standard cataract surgery.
- Laser-assisted cataract surgery is not covered by your insurance.
If you have any further questions about cataract surgery, please don’t hesitate to call our office.
-Doctors Tarantino and Cho
Tarantino Eye Center