Editor’s note: One of the many benefits associated with an online information center and website, such as VisionAware, is the ability to track readers’ search terms [i.e., information readers are seeking as they search the Internet]. Since the earliest days of VisionAware.org, the following questions about cataracts and cataract surgery consistently rank within the top ten searches and are especially relevant during Cataract Awareness Month:
- Is it true that cataract surgery now can be performed entirely by laser?
- How can I find out more about laser surgery for cataracts?
An Answer from Tina D. Turner, M.D.
This week, our answer comes from Tina D. Turner, M.D., a staff comprehensive ophthalmologist at Henry Ford Health System’s Grosse Pointe Ophthalmology and author of An Introduction to Cataracts and Cataract Surgery on the VisionAware website. She lectures widely on many topics in ophthalmology to ophthalmology residents, family medicine residents, emergency medicine residents, ophthalmic technicians, surgical technicians, and patients.
Performing Cataract Surgery
Most cataracts are highly treatable. Cataract surgery is one of the most common surgeries performed in the United States, with approximately 98% of patients experiencing improved vision if there are no other eye conditions present.
Two very small incisions (one larger, approximately three millimeters, or one-tenth of an inch, and one smaller, approximately one millimeter, or one thirty-second of an inch) are made in the cornea, which is the transparent dome-shaped tissue that covers the front part of the eye. A thick, sticky, glue-like material (called “viscous”) is injected into the front part of the eye to help maintain its shape during surgery. This material is made from substances that occur naturally in the body. Because it is thick, this material will not leak out of the incisions during surgery.
Phacoemulsification
The surgeon creates an opening in the natural “sac” or “bag” that holds the lens in place, called the lens capsule. The lens is separated from the lens capsule by using a balanced salt solution.
Once the capsule is open and the lens can move freely inside the capsule, a special ultrasound device is used to break the lens into small pieces and suck it out of the eye. This technique is called phacoemulsification.
Prior to the development of phacoemulsification, the lens used to be removed in one solid piece through a very large incision (8-12 millimeters). That surgery entailed considerably more risk and had a significantly longer recovery time.
After the lens is removed, additional viscous material is injected into the lens capsule to hold it open and make room for the new artificial lens. The folded artificial lens is inserted into the “sac” or capsule, where it is then allowed to unfold.
The viscous material that maintained the shape of the eye during surgery is removed. The two incisions usually self-seal and do not require stitches.
Phacoemulsification was introduced more than 40 years ago and is now the most common method surgical method used to remove cataracts.
The Femtosecond Laser Does not Take the Place of Manual Cataract Surgery
The role of lasers in the removal of cataracts is beginning to unfold in the United States. Femtosecond lasers have been used in ophthalmic surgery since 2001, and in the late 2000s, work began on their use in cataract surgery.
In 2008, the first laser-assisted cataract surgery was performed in Hungary. After gaining FDA approval, the first laser-assisted cataract surgery was performed in the United States in 2010. Since that time, it has been gaining acceptance and popularity.
The laser does not take the place of manual cataract surgery; instead, the laser “assists” in the removal of the cataract. Phacoemulsification is still used to remove the cataract itself.
The laser performs three key steps in the cataract surgery procedure:
- the corneal incisions
- opening of the capsule containing the cataract
- the initial sectioning of the cataract into smaller pieces.
It performs these three steps with incredible precision, and it is this aspect that may prove it to be superior to the current technique in which these steps are manually performed by the surgeon. The laser can also be used to make incisions in the cornea to treat certain types and amounts of astigmatism.
Further data and well-designed studies are needed to prove that this method is associated with better outcomes and fewer complications than phacoemulsification alone, and much work is being done on this front.
Because insurance does not cover the cost of having laser-assisted cataract surgery, patients are required to contribute a significant out-of-pocket payment. It is important to discuss with your physician what type of procedure would be best for you.