There are two major types of surgery that can be performed on eyes clouded with cataracts — one uses lasers, and the other does not. Laser cataract surgery comes with a higher level of precision, and it is considered marginally safer than traditional surgery. Laser surgery is also the best choice for people dealing with eye conditions such as astigmatism.
Using a doctor with extensive laser experience is vital, as errors can happen as doctors learn the technology. Laser surgeries can also cost you more, as insurance may not pay for this kind of care.
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How Does Cataract Surgery Work?
Cataracts are a clouding of the lens that sits within your eye. During cataract surgery, your doctor makes an incision to the surface of the eye. An instrument is pushed into that incision, and sound waves are pushed through the lens to break it apart. Those lens pieces are removed via suction, and a new lens is placed into the eye via that same incision.
In a traditional cataract surgery, the incision is made with a scalpel. With laser surgery, the incision is made with a laser. In both cases, surgeries are performed by a skilled doctor with years of training. The major difference involves the tools your doctor uses as the surgery unfolds.
In addition, according to the American Academy of Ophthalmology, an imaging device is used during laser surgery to map the surface of the eye and the surface of the lens. This step is only used with laser surgery, and it can help the doctor to plan for the exact size, depth, and location of the incision. The laser can also be used to soften the cataract before surgery.
During a laser-assisted surgery, your doctor can rely on the programming within the machine as well as their skills developed during medical school. Combining machine learning with human skill can result in a much different type of surgery, but it is not the right type of surgery for everyone.
Safety and Efficacy Make Laser Surgery a Good Choice
Laser-assisted surgery allows your surgeon to develop a deep understanding of your eyes and your cataracts before the first cut is made. As researchers writing in the journal Ophthalmology and Therapy point out, this can help to increase the accuracy and precision of the cuts made during surgery. That can be vital when doctors are working on eyes that are delicate due to age or underlying disease. A very small error could lead to a very big issue, and a laser could make those errors a little less likely. The doctor will have the computer's expertise to lean on during the procedure.
Since this technology is somewhat new, researchers have performed many studies to determine how well it works and whether or not it is safe. The results of those studies may be reassuring to you if you are concerned about having surgery performed on your eyes.
For example, in a study in the Journal of Cataract and Refractive Surgery, researchers examined the eyes of 170 people who had laser cataract surgery. The researchers found that no eye lost visual acuity due to complications from the surgery, and as a result, this surgery type could be considered safe.
In a study comparing laser surgery to conventional surgery, published in the Journal of Cataract and Refractive Surgery, researchers found that those who had laser surgery had slightly better vision after the procedure when compared to those who had conventional surgery. Both sets of people came very close to the targets set by their surgeons, but those who had laser correction had slightly better scores that could mean a lower risk of wearing glasses.
Studies like this seem to suggest that the mapping done as part of a laser procedure gives your surgeon information that can be used to improve how well you can see when the surgery is done. Those results could mean the difference between never wearing glasses again and keeping readers on hand at all times.
In a similar study, published in the International Journal of Ophthalmology, researchers found that 80 percent of surgeons had a lower rate of complications when they used lasers to help patients rather than using conventional surgery. Some of the complications mentioned were small, and that means patients may not have noticed the errors researchers were measuring. But this result does suggest that laser surgery could allow for prevention of some errors that could block clear vision.
Laser Is Best for Some Conditions
It is easy to discuss laser surgery and conventional surgery as two options patients must choose from. In reality, some people have conditions that require the use of lasers during cataract surgery.
For example, according to Mayo Clinic, people with astigmatism may need laser surgery in order to address vision issues during cataract surgery. For these people, irregularities in the shape of the eye keep images from coming in clearly. A standard cataract surgery may not be able to address that shape issue, but it can be addressed with laser surgery.
In addition, some types of cataract lenses must be implanted with laser surgery. The incisions they require for proper placement must be created carefully and in just the right spots, and that precision may not be possible without the use of a laser.
Doctors’ Skill Level Matters
While laser technology offers your doctor assistance during surgery, the machinery can be complex, and it can take time to learn how to optimize that equipment. That can mean that doctors who are new to the equipment can be going through a learning period that could result in damage to your very delicate eyes.
For example, in a study published in the Journal of Cataract and Refractive Surgery, researchers found that all complications that occurred during laser cataract surgery happened during a doctor's first 100 cases. After the doctor had completed 100 cases, those errors disappeared.
Research like this suggests that patients should ask their doctors about their experience with the laser before they schedule surgery. If the doctor has not used the equipment extensively, the precision and safety patients expect may not be available.
Laser Surgeries Can Be More Expensive
If laser surgeries are more precise and lead to better outcomes, you may wonder why all doctors and their patients do not rely exclusively on the new technology. Cost is the issue that blocks widespread use.
As an article in Review of Ophthalmology makes clear, not all insurance plans will cover cataract surgery done with a laser. That means doctors who want to use a laser may have to ask their patients to pay for that care, and some doctors resist the idea of asking their patients to pay. In addition, some doctors may not want to pay for machines they are not sure they will be able to use extensively.
If cost is a concern for your family and your insurance company will not pay for laser-assisted surgery, a traditional surgery may be the right choice for you. This type of surgery is also considered safe, and your insurance company may pay for your care without asking you to pitch in.
We Can Help You to Decide
At NVISION, we know you have options in terms of your health care. We also know that those options can be more than a little confusing. Let us help.
We can connect you with a skilled practitioner who can examine your eyes and explain your options to you in terms you can understand. If you choose laser surgery, we offer that technology in our office, and we can guide you through your recovery. If cost is a concern, we can discuss payment plans with you. Please contact us to talk with a surgeon in your area.
Traditional Cataract Surgery vs. Laser-Assisted Cataract Surgery. (August 2017). American Academy of Ophthalmology.
A Review of Laser-Assisted Versus Traditional Phacoemulsification Cataract Surgery. (February 2017). Ophthalmology and Therapy.
Initial Evaluation of a Femtosecond Laser System in Cataract Surgery. (January 2014). Journal of Cataract and Refractive Surgery.
Comparison of Visual Recovery and Refractive Stability Between Femtosecond Laser-Assisted Cataract Surgery and Standard Phacoemulsification: Six Month Follow-Up. (July 2015). Journal of Cataract and Refractive Surgery.
Comparing the Intraoperative Complication Rate of Femtosecond Laser-Assisted Cataract Surgery to Traditional Phacoemulsification. (February 2015). International Journal of Ophthalmology.
Complications of Femtosecond Laser-Assisted Cataract Surgery. (January 2014). Journal of Cataract and Refractive Surgery.
Who's Getting Femto Laser Cataract Surgery?(March 2015). Review of Ophthalmology.