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Should I choose laser cataract surgery?

01/09/2017

Should I choose laser cataract surgery?

Vision Eye Institute surgeons review the literature1

Cataracts are one of the leading causes of blindness around the globe and are particularly prevalent in older people. So it’s not surprising that cataract removal to restore vision, by removing the cloudy lens and replacing it with an artificial one (known as an intraocular lens or IOL), is one of the most frequently performed surgeries.

Traditional cataract surgery involves the ophthalmic surgeon manually completing all steps of the surgery. However, the last few years have seen a major advance in cataract surgery – in the form of femtosecond lasers. The laser performs several steps that would have normally been performed manually by the surgeon.

Both manual cataract surgery and laser cataract surgery (also called femtosecond laser cataract surgery (FLACS) and laser-assisted cataract surgery) are highly effective and safe procedures.

In addition to restoring vision, cataract surgery also presents an opportunity to correct pre-existing refractive errors. However, along with these technological advances come higher patient expectations regarding outcome and safety. The Alcon LenSx laser platform was the first laser to obtain both US and European approval and was commercially released in 2011, with ongoing software and hardware updates. Consequently, there are numerous peer-reviewed articles discussing the performance and safety of the LenSx laser.

Vision Eye Institute surgeons have taken the opportunity to review the available information and implications for patients, given that this state-of-the-art laser is used in several of our clinics.

How it works

The LenSx laser beam is directed using an integrated video microscope and high-definition optical coherence tomography (OCT) scanner, a sophisticated tool used to image the retina at the back of the eye. The laser is connected (‘docked’) to the patient using a soft curved contact lens connected to a sterile suction ring (SoftFit). Earlier versions of LenSx used a rigid contact lens docking system, while other laser platforms may use a fluid interface. Accurate docking is essential to allow precise delivery of the laser beam (in the form ultrasound energy), as well as physically stabilise the eye. The surgeon then maps and programs the treatment plan into the laser platform.

What it’s used for

Different laser platforms have different approved indications. The LenSx platform is approved for the following:

  • Corneal incision – cutting through the cornea, which is like the clear windscreen of the eye
  • Capsulotomy – cutting through the capsule surrounding the affected lens
  • Lens fragmentation – breaking the affected lens into pieces for removal

Patient outcomes

  • Precise, consistent and stable corneal incisions, reducing the risk of post-operative leakage
  • Precise, consistent and intact capsule opening*
    • Stable IOL position, which can minimise blurry vision, halos, glare and flickering and enhances image quality and contrast – this is particularly beneficial with multifocal and trifocal IOLs, which require more precise positioning to achieve maximum effect (compared to monofocal IOLs)
    • The LenSx-generated capsulotomy most closely resembles the appearance of a manual incision, compared to other laser platforms
  • Reduced incidence of tears in the lens capsule (0.1% for LenSx/SoftFit)
  • Potentially less risk of post-operative capsule thickening, which can cause cloudy vision (known as posterior capsule opacification)
  • Markedly reduced time and ultrasound energy required to complete lens fragmentation, meaning less trauma to the eye
  • Allows correction of refractive errors and corneal astigmatism in a more precise and consistent manner
  • Successfully used in hypermature and white cataracts, which are at higher risk of capsule tear and capsule rupture
  • Ability to customise lens fragmentation to the type and density of the cataract

*The capsule incision, a critical factor in the success of the entire procedure, is recognised as the most difficult step by trainee surgeons

Safety implications

  • Short, transient increase in intraocular pressure (inside the eye)
    • Currently, there is no evidence that this causes any short- or long-term complications; however, potential risks and benefits of laser cataract surgery should be discussed for all patients, including those with optic nerve disease, such as glaucoma
  • Routine inspection of the laser-cut capsulotomy prior to lens fragmentation allows identification of capsules at high risk of tearing and appropriate modification of surgical technique

Summary

The literature confirms that the current LenSx platform is more advanced, safer and faster than previous versions. Coupled with increasing surgeon experience around the world, laser cataract surgery offers a consistent and precise surgical outcome, which can benefit many patients. Patients should take into consideration the experience of the surgeon in performing laser cataract surgery, as well as manual cataract surgery, and have a comprehensive discussion with their surgeon regarding benefits and risks.

Vision Eye Institute has a number of ophthalmologists who specialise in cataract surgery, including laser cataract surgery. For a list of our cataract clinics, click here.

Any surgical or invasive procedure carries risks. You should have a comprehensive discussion with your ophthalmologist before making a decision to proceed.

Reference
  1. Roberts T, Lawless M, Sutton G, Hodge C. Update and clinical utility of the LenSx femtosecond laser in cataract surgery. Clin Ophthalmol 2016;10:2021–29.

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