Modern cataract surgery continues to steadily improve as far as both results and safety. Arguably, it is the best surgery known to mankind. Our current technique, phaco emulsification, involves the use of ultrasound power to break up the cloudy lens and it is then aspirated through the same tiny incision. Until recently, despite the assumption by many patients that this has been the case for decades, no laser was used as part of this procedure. This confusion has occurred simply because ophthalmologists have used lasers for over twenty-five years to treat glaucoma, retinal disorders and so on. More recently, the Excimer laser has been used to perform LASIK.
Presently, several eye surgery manufacturers have brought laser cataract surgery machines to market. These can be used to perform various steps of the surgical procedure. None of these machines is able to be used for the entire procedure. They are used in addition to our standard procedure of phaco emulsification. Specifically, the laser cataract machines are used to perform incisions into the eye, incisions to alter the shape of the eye (reduce astigmatism), open the lens capsule and sculpt the lens into smaller pieces. Among the various machines on the market, some may be approved for more uses than others and one may perform a particular step better than the competition.
What does this mean for both surgeons and patients? Theoretically, using the laser for certain steps of the procedure means greater precision and safety (less ultrasound power used). To date, however, no one has demonstrated improvement in the most important result which is the ability to see in uncorrected fashion. That is, the ability of one to see both in the distance and up close without the aid of either glasses or contacts. In addition, the issue of cost certainly has to be addressed. As with most new medical machines and procedures, the new technology has a high price tag for which someone has to pay. Currently, this burden is placed on the patient in that payers are not covering the cost and so the extra fees are out-of-pocket to the patient.
To summarize, the addition of the laser to our cataract procedure is both exciting and complicated. I do believe that in the future improvements in both safety and efficacy will be demonstrated to our already amazingly successful procedure. Perhaps, one day insurers may become aware of such results and assist in covering the cost. As with all major decisions regarding your medical care, communication with the doctor is imperative as this issue is certain to change rapidly over the next several months to years. Stay tuned!