Perhaps the Greatest Advance in Cataract Surgery
Cataract surgery is one of the true success stories in medicine. During my practice life, there have been numerous advancements, all of which make the surgery safer with more predictable outcomes for patients. Most of my patients leave the operating room without a patch and resume their normal activities the next day. The interesting thing is that all of the advancements have been incremental improvements on what has gone before.
Now, a real game changer has come along. Femtosecond laser technology has been used in the last 10 years or so to create the flap for LASIK surgery. The buzzword for this was “bladeless” LASIK surgery and it is now the standard of care. The computer guided laser can make a flap in the cornea with more precision than a blade can perform.
Now, Femtosecond lasers are being used for cataract surgery. Traditionally, all of the incisions in the eye are made by hand, but since the surgeons are all human, there is variability not only between different surgeons, but also variability by the same surgeon doing different patient’s surgeries! This variability leads to less predictable surgical outcomes.
Let’s backup and try to understands what this means. One of the goals of cataract surgery today is to not only remove the cloudy natural lens and replace it with an artificial lens (IOL), but to make the eye less dependent on glasses. We have all kinds of ways to measure the eye and calculate what power IOL to use, but consistency of the surgery is the key to having a consistent and predictable outcome.
That’s where the new technology comes into play! The Femtosecond laser is guided by an unbelievably accurate imaging system that allows the surgery to be preformed with accuracy and reproducibility never before achieved. One of the most challenging parts of cataract surgery is to create a round 5mm opening in the capsule that holds the natural lens. Although doing this by hand is possible, is it always a perfect circle? Is it always exactly 5mm? Is it always perfectly centered? If performed with the laser, the answer is “yes”!
The only problem I see with this technology is the cost. Medicare and other insurers don’t care if you do the surgery with a $2 blade or a half a million dollar laser – they pay the same either way. Current reimbursement will not allow for the laser to be used routinely, but patients will be allowed to pay for this option.
So let’s see……..these are your eyes. Is it worth the out of pocket expense for the increased safety and more predictable outcome? I think so!