Laser Cataract Surgery

Comments from the Tomoka Eye doctors

Cataract surgery is a highly developed operation that has undergone many improvements over the years. Ultrasonic phacoemulsification, viscoelastic gels, and premium implant technologies have improved surgical technique and decreased operative risk. Today, cataract surgery is the most common surgical procedure performed across America.

Laser cataract surgery is the newest advancement in this field.  With “bladeless surgery,” a laser beam is used to perform several steps of the operation. This refinement improves the overall “precision” of your surgery and may make your operation safer and more predictable.

What is laser cataract surgery?
With laser cataract surgery, several steps of the operation are performed using a precision laser and sophisticated computer tracking.  The initial corneal incisions are constructed with the laser and the cataract is actually “broken up” using the laser.  The laser can be used to make precise cuts in the peripheral cornea to minimize astigmatism.  This makes the operation safer and improves your vision afterwards.

Is this the same thing as “bladeless” surgery?
Yes.  Instead of using a steel scalpel to make our incisions into the eye, we use the laser.  This allows more control and decreases the chance of a wound leak afterwards.

Is the cataract removed by the laser?
While the laser helps us “break” the cataract apart, the laser doesn’t actually “remove” the lens itself.  The operation still involves entering the eye and manually removing the cataract fragments using a vacuum (phacoemulsification).  The overall process of cataract surgery is largely unchanged – the cloudy cataract is still removed and replaced with a clear lens implant.

What are the benefits to having laser?

There are several benefits to laser surgery:

  1. The main incisions into the eye are created in a “bladeless” fashion. These incisions are easier to place and their precise construction results in less “wound leakage” afterwards.
  1. Small amounts of astigmatism are easier to fix as the laser can create “relaxing incisions” to minimize corneal distortion.
  1. The capsulorhexis (the round hole created in the front part of the cataract) is created with the laser. This leads to decreased intra-operative risk and potentially better alignment of the implant inside your eye.
  1. The laser helps to break up the cataract itself, leading to less phacoemulsification energy needed inside your eye. This means less trauma and potentially a quicker healing time after surgery.

Why are you using the laser now?
We take great satisfaction in being on the forefront of new technology, but not at the risk of “experimenting” with your eyes with unproven technology. The first generation of cataract laser had limitations. We wanted to make sure the kinks were “worked out” before bringing this technology to our community. The latest generation of lasers have a proven track record of good results so we are now offering this advancement to our patients.
What is astigmatism?

The surface of the cornea (the clear window that makes up the front of your eye) is normally spherical and round like a basketball.  With astigmatism, however, the cornea is shaped more like a football. It is steeper along one axis, and flatter along another.

We all have a little astigmatism, but some people have a lot.  Traditional cataract surgery doesn’t eliminate this astigmatism, meaning you would likely need glasses to fix this after surgery.

How do you fix astigmatism using glasses and contacts?
Astigmatism is easy to fix with glasses.  When we make your glasses, we grind the “mirror image” of your football into the glass itself, and rotate the lenses in your frames so that the footballs “cancel” each other out.  This gives you very clear vision (though it can make your glasses thick and cause distortion at the edge of your frames).

We can also fix astigmatism with contact lenses, but this is harder.  We can melt the correcting football into the front of a contact lens (this is called a “toric contact”) but contacts have a tendency to spin on the surface of the eyeball.  Every time you blink, your contact can rotate, and the footballs go “off axis” from each other. This gives you intermittent blurry vision as the contact spins around all day.

How do Toric implants fix my astigmatism?

The Toric implant has the “football” correction built in.  After injecting this implant inside the eye, we rotate the toric implant around a 360-degree axis until the football has lined up perfectly to counteract your eye’s football.

This results in a much better (and more predictable) refractive result. You still might need some glasses for the best distance vision, but you’ll be a lot less dependent on them.
Will the laser fix my astigmatism?
The laser can also eliminate astigmatism by reshaping the corneal surface with precisely placed corneal incisions. The laser, combined with the Toric implant, allows us to treat a wide range of astigmatism and do so more precisely than in the past. This further decreases your dependence on glasses after surgery.

How is “cataract laser” different than LASIK?

LASIK surgery involves sculpting and resurfacing the corneal surface of your eyeball in order to improve your visual focus.  The cataract laser uses similar technology but actually creates incisions through the cornea.  The cataract laser can also penetrate deeper and is capable of working inside the eye to break up the cataract itself.

Will I still need glasses after laser-assisted cataract surgery? 
Laser assisted surgery is a more precise way to perform your operation.  The laser helps to minimize your astigmatism and make your end results more predictable.  The laser will decrease the likelihood that you’ll need glasses afterwards, but there is still no way to guarantee you’ll be completely glasses free.  We choose your implant’s “strength” based upon sophisticated calculations.  However, everyone’s internal eye anatomy is different and no calculation can compensate for these individual variations. Even with a “perfect” laser-assisted procedure, there is still the possibility that you will need glasses for the best vision.

Will laser surgery fix my near vision?

Cataract laser won’t fix your near vision.  The standard and Toric implants we use are designed to be “mono-focal” and are usually set for distance vision.  If you want to have good near vision as well, the “multi-focal” Restor lens may be an option.

What will the laser feel like during my actual surgery?

Normally, cataract surgery takes about 10-15 minutes to perform. The laser will make the surgery take a little longer as it requires a few minutes to setup.  We will numb your eye with drops so you won’t feel anything.  To apply the laser, a docking “gadget” is gently placed onto your eye. This does not hurt, though you may feel mild pressure.  During the laser application, you won’t feel anything but your vision will become blurry.  We will talk you through this entire process.  After the laser is applied, we remove the laser assembly and proceed with your cataract procedure.  Don’t worry about feeling nervous during any of these steps – we will give you plenty of numbing medicine and can give you more relaxing medicine via your IV if you need it.

Am I a good candidate for laser?

Most people are good candidates for laser cataract surgery. There are a few exceptions, such as people with small pupils, small eyes, corneal opacities, and certain types of glaucoma. Every eye is different, so we’ll talk about the relative benefits for you during your consultation and when you come in for your pre-operative measurements.

Why does laser cataract cost more?
Medicare (and most insurance plans) cover the cost of your cataract surgery, which includes the procedure and post-operative visits.  However, laser surgery (and premium implants) are not covered.  We have attractive financing plans, however, to minimize any financial burden.

This is overwhelming. Can you list my surgical options again?

At this point, you may find yourself overwhelmed with options. Modern technology has given us many lens choices (standard, Toric, Restor), and now we have added laser cataract surgery!  With this many options, it may be hard to decide what procedure is correct for your eyes.  Generally speaking, you’ll fall into one of these four categories:

  1. Manual Surgery with a Standard Lens

This is the traditional cataract surgery using the standard single-vision lens implant that is covered by your medical insurance. Traditional cataract surgery has an excellent track record and Tomoka Eye has decades of experience with this procedure. Your vision should be much improved after standard surgery, though there is a good chance that you will still need glasses for perfect distance vision. You will definitelyneed bifocals for close-up work.

  1. Laser Surgery with a Standard Lens

This upgrade utilizes the cataract laser to assist with your operation. This is an excellent choice for people who have small amounts of astigmatism and want to use the latest technology to minimize complications and maximize results. You may still need glasses for distance, but your uncorrected “glasses-free” vision will likely be better than otherwise. You’ll still need a bifocal or reading glasses for close-up work.

  1. Laser Surgery with a Toric Lens

For people with moderate or large amounts of astigmatism, this is the best option. The Toric implant is capable of eliminating massive amounts of astigmatism and this drastically decreases your dependence on glasses after your operation.  You may still need glasses afterwards, but they will be much thinner and more comfortable than what you’d end up with otherwise.  The Toric implant is a wonderful lens technology and the laser makes this implant work even better. You’ll still need glasses for reading.

  1. Laser Surgery with a Restor Lens

If your goal is to become less dependent on glasses overall, the multi-focal Restor implant may be the best option. This implant has concentric rings built in that help you focus on both distance and near objects. We always use the laser when inserting this lens as it helps to eliminate residual astigmatism, and the laser helps us center the Restor lens in its proper place inside the eye. The Restor isn’t for everyone, but laser-assisted surgery is making this option even more predictable than in the past.

No matter what you choose for your cataract surgery, chances are that you will have a great result.  We wouldn’t recommend cataract surgery if we didn’t think it would help your vision.  If you have questions about these options, however, make sure we answer any concerns prior to surgery.  You deserve to go into your surgery confident that you’ve made the best choice for your eyes.