Recently some surgeons have been offering their patients cataract surgery that uses lasers in place of traditional tools. Laser cataract surgery is newer and more expensive, but is it better? Dr. David C. Brown explores the latest science in this special update.
Are Newer Surgical Techniques Always Better?
Cataract surgery involves removing the clouded natural lens of the eye and replacing it with a clearer synthetic lens. It’s one of the most common and successful surgeries today, being performed three million times each year in the United States.
Decades ago, cataract surgery wasn’t as common or successful. In the 1960s, surgeons made large incisions in the eye to remove the lens in one piece. Patients required general anesthesia, sutures, and more than a month of recovery time.
After the 1960s, surgeons began using a needle vibrating at ultrasonic speeds to break the lens into extremely small pieces and remove it through a tiny incision. The incision was small enough to heal on its own without sutures, which decreased recovery times and rates of infection. Cataract surgery now enjoys a 98% or higher success rate.
If traditional cataract surgery has such an excellent track record, why are some surgeons switching to laser cataract surgery? In a word: LASIK.
Since it was introduced to the United States in 1999, LASIK has proven that powerful pulses of light can do some things that metal instruments can’t. Lasers have sculpted the natural shape of the eye accurately enough to improve nearsightedness, farsightedness, and astigmatism for millions of people.
Can similar laser technology enhance the ultrasonic needle of traditional cataract surgery? Some cataract surgeons think so, but new scientific studies are beginning to tell a different story.
Does Laser Cataract Surgery Cause Swelling in the Retina?
In 2015 researchers in Australia studied laser cataract surgery patients by examining the amount of swelling in the center of the retina, the area responsible for the most detailed vision. They compared it to the swelling in patients who had traditional cataract surgery. The laser cataract surgery patients had significantly more retinal swelling.
Verdict: Laser cataract surgery may adversely affect the retina, at least temporarily.
Does Laser Cataract Surgery Worsen Dry Eye?
Since traditional cataract surgery can cause dry eye, researchers in China recently compared traditional cataract surgery patients to laser cataract surgery patients to see if there was a difference. Both groups of patients had drier eyes after surgery, but laser cataract surgery patients had it worse, especially patients who had dry eyes before the surgery.
Verdict: All cataract surgery has a risk of dry eye, but laser cataract surgery has a higher risk.
Does Laser Cataract Surgery Provide Clearer Vision?
Perhaps patients would pay more and risk more side effects if laser cataract surgery ultimately provided better vision than traditional cataract surgery. To find out, researchers in Australia compared the visual results of cataract surgery patients between 2012 and 2014. The result? Patients receiving laser cataract surgery did not have meaningful improvements in vision compared to patients receiving traditional cataract surgery.
Verdict: Laser cataract surgery doesn’t provide clearer vision than traditional cataract surgery.
Do Laser Cataract Surgery’s Pros Outweigh its Cons?
According to an analysis of 15 scientific trials and 22 studies published between 2007 and 2016, there was no statistically significant difference in the visual acuity of patients who underwent laser or traditional cataract surgery. And while laser cataract surgery showed an improvement in some surgical outcomes, it also was associated with higher prostaglandin concentrations (the body’s natural response to injury) and higher rates of capsular tears (damage to the extremely thin capsule, or membrane, that holds the lens in place). These findings led Medscape to compare the two forms of surgery as “equivalent.”
Is Laser Cataract Surgery’s Increased Cost Justified?
Laser cataract surgery requires newer and more specialized technology than traditional cataract surgery, making it more expensive. This prompted researchers in Australia to study its cost effectiveness. If laser cataract surgery could provide better vision for more years with fewer complications, perhaps the increased cost would pay for itself in the long run. However, the researchers found that laser cataract surgery doesn’t provide better vision for more years and doesn’t have fewer complications.
In fact, laser cataract surgery has a higher risk of several complications, such as swelling of the cornea, swelling of the retina, haze behind the lens, trauma to the cornea, and rupture of the capsule that holds the lens.
Verdict: Laser cataract surgery’s increased cost isn’t justified because it doesn’t provide better vision and it may lead to more complications.
Does Eye Centers of Florida Recommend Laser Cataract Surgery?
Until laser cataract surgery can offer better results than traditional cataract surgery, we at Eye Centers of Florida believe it’s best for patients to choose traditional cataract surgery. That’s why we currently don’t recommend laser cataract surgery to our own patients, but we continue to evaluate laser cataract surgery and other developing technologies.
David C. Brown M.D., F.A.C.S.
Eye Centers of Florida Founder
- American Society of Cataract and Refractive Surgery, http://www.allaboutvision.com/conditions/cataract-complications.htm
- Charles D. Kelman, History of Phaco Surgery, http://www.elibraryweb.net/cataract/History%20of%20Phaco.pdf
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- Yu, et al.: Evaluation of dry eye after femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2015 Dec;41(12):2614-23. http://www.ncbi.nlm.nih.gov/pubmed/26796442
- Ewe SYP, et al.: A Comparative Cohort Study of Visual Outcomes in Femtosecond Laser-Assisted versus Phacoemulsification Cataract Surgery. Ophthalmology. 2016 Jan;123(1):178-82 http://www.ncbi.nlm.nih.gov/pubmed/26526634
- EyeNet Magazine, February 2016, page 21.
- Popovic, Marko et al.: Efficacy and Safety of Femtosecond Laser-Assisted Cataract Surgery Compared with Manual Cataract Surgery. Ophthalmology, Volume 123, Issue 10, 2113-2126. http://www.aaojournal.org/article/S0161-6420(16)30607-8/abstract