Laser Cataract Surgery

Question: I have a cataract and am being offered cataract surgery via laser cataract surgery. The cataract surgeon says he has done 200 of them --all successfully and has been doing LASIK surgery for the last 10 years.  Is this new procedure for cataracts safe and effective for a 56 year old woman with no other problems other than needing cataract removal in both eyes?


Answer: Laser Cataract Surgery has been available in the US for about a year or so and is slowly growing in adoption as an advanced method of Cataract Surgery. It is growing slowly as a result of the economic barriers in front of it rather than any know technical or surgical questions. The incorporation of the femtosecond laser to consolidate a number of the manual skill intensive steps of the Cataract operation into a surgeon directed and controlled  laser application does have the promise of making those steps more reliable and precise-even in the hands of lesser skilled Cataract Surgeons. You should know however that Laser Cataract Surgery does NOT replace a good portion of the procedure which IS highly skill based. This is the phacoemulsification portion of the procedure. The laser can be directed by the surgeon to create a perfect entry incision architecture with complete reproducibility, to perfectly open the anterior capsule of the lens for access to the cloudy lens material, soften the lens material for extraction and even correct small degrees of astigmatism-BUT NOT to carefully and cleanly remove the cloudy lens material through the incision via phacoemulsification which is EXTREMELY skill based. This Laser Cataract Surgeons are recognizing the technical improvements the procedure can deliver in the steps listed above, However, the cost of the laser is very high, its service costs are high, there is a fee due to the manufacturer for each procedure and NONE of the incremental Laser Cataract Surgery cost is covered by insurance or Medicare-thus it is slow to be adopted. So-the clinical results and data thus far suggest that Laser Cataract Surgery is indeed safe and effective and may very well represent a improvement in results through the reduction of the variability of certain steps caused by manual surgery.

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