Bladeless Cataract Surgery
In the United States, over 3 million cataract surgeries are performed each year. While traditional cataract surgery using surgical blades is very safe, the introduction of Toric or multifocal intraocular lenses demands very precise lens positioning for optimal outcomes. That’s the reason why we now offer bladeless cataract surgery at the Eye Institute at Medical Center Clinic. This surgery uses femtosecond lasers to make all the necessary incisions with incredible accuracy. These FDA-approved lasers are similar to those used to create the corneal flap in all-laser LASIK.
How have lasers replaced hand-held surgical tools?
In laser cataract surgery, the femtosecond laser replaces or assists the use of hand-held surgical tools for the following steps:
- The corneal incision
- The anterior capsulotomy
- Lens and cataract fragmentation
- Astigmatism correction
Lasers can improve the precision, accuracy, and reproducibility of each of these steps. This reduces the risks involved with cataract surgery (although they are already very low with traditional surgery, as well) and improves lens placement and the patient’s final vision.
How is laser cataract surgery done?
1. Corneal incision
Our surgeons create a precise surgical plan for the corneal incision with a sophisticated 3D image of the eye called an optical coherence tomography (OCT). The laser will create an incision with a specific location, depth, and length in all planes. Normally, there is some variation involved with the experience of the surgeon, but the laser makes the incision perfectly every time. This has two benefits: it improves accuracy, and it makes for a better self-sealing incision without the need for stitches.
The second step removes a portion of the thin capsular membrane that surrounds the natural lens. This provides access to the cataract. It is important that the remainder of the lens capsule remains intact and undamaged, as it must hold the artificial lens in place. When a laser is used for the capsulotomy, studies have shown it to be more accurate and reproducible (fewer than 1 in 10 manually created capsulorhexi achieve the same accuracy). This allows better positioning of the intraocular lens and better final vision.
3. Cataract fragmentation
After the capsulotomy, ultrasonic energy is used to break up the cataract, which is then vacuumed away. This is called phacoemulsification. In traditional cataract surgery, the ultrasound energy necessary to break up the cataract can lead to heat buildup in the incision through which the ultrasound device is inserted. This heat can burn the incision and actually induce astigmatism. It may also make it necessary to close the incision with sutures. The laser softens the cataract as it breaks it up. Less ultrasound energy is then needed to finish breaking up and removing the pieces of the cataract. This dramatically lessens the chances of burning and distortion of the incision. There is reduced inflammation and trauma to the eye, which makes for a faster, easier recovery period.
4. Astigmatism correction
With the newer intraocular lens options that correct for presbyopia (farsightedness that usually accompanies aging), it is important that there is little or no astigmatism present on the eye. To reduce astigmatism (where the cornea is shaped more like a football than the preferred shape of a baseball), small incisions are made in the periphery of the cornea. Using the OCT from the 3D image, the laser allows incisions that are very precisely located, and to the perfect length and depth. This precision increases the probability of excellent vision without needing glasses after the cataract surgery.