Choosing Between Traditional and Laser-Assisted Cataract Surgery by Shunai Jiang, M.D., Ph.D.

April 28, 2020

Dr. Jiang is an ophthalmologist, cataract surgeon, and glaucoma specialist at the Marietta Eye Clinic.

Cataracts, which naturally occur with age, cause vision changes and eventually vision loss. Most people will start to develop signs of cataracts by age 60. Initially, your ophthalmologist will likely want to monitor the progression. He or she will likely treat the development of cataracts by updating your prescription for glasses or contacts as necessary. When your lenses become so clouded that updates to your prescription no longer help, your doctor will likely suggest surgery to remove your cataracts. You may opt for traditional cataract surgery or laser-assisted cataract surgery.

Traditional Cataract Surgery

Traditional cataract surgery is one of the safest and most commonly performed surgical procedures in the world. It is performed manually by an eye surgeon using a surgical blade. First, an eye surgeon makes a small incision in your cornea and another in the capsule containing the clouded lens. A probe is inserted into the capsule, and ultrasound waves are used to break up the cataract. The broken pieces of the cataract are then removed, and an artificial replacement lens, called an intraocular lens (IOL), is inserted. The incisions usually do not require stitches.

Laser-Assisted Cataract Surgery

Laser-assisted cataract surgery is an advanced type of cataract surgery that uses femtosecond laser technology to bring a new level of precision and accuracy to specific steps in cataract surgery. In laser-assisted cataract surgery, a camera or ultrasound device is used to map the surface and internal structures of your eye. The surgeon then uses the laser to make two small incisions at the exact size, depth, and location ideal for your eye. The surgeon also uses the laser to make an opening in the capsule that contains your clouded natural lens and fragment the lens. He or she then use the laser to make relaxing incisions on the peripheral cornea to correct astigmatism. Like in traditional cataract surgery, an ultrasound probe is then used to remove the cataract. Finally, the IOL is inserted. The incisions usually do not require stitches.

What are the Differences?

Laser-assisted surgery is very precise. The laser allows your surgeon to make incisions that will center the IOL as much as possible. Additionally, because a laser can be used to soften the cataract, less sound wave energy is needed to break it up, which may reduce inflammation and corneal edema. Laser-assisted cataract surgery may be especially advantageous if you have some sort of intraocular irregularity, such as endothelial dystrophy or loose zonules.

Who is a Good Candidate for Laser-Assisted Cataract Surgery?

You can select laser-assisted surgery if you meet 1 of 2 conditions:

  • You choose a premium IOL — accommodative, multifocal, or toric lenses — or
  • You have astigmatism and choose to have it corrected during surgery.

Use of a laser might be recommended with premium IOLs because the alignment of the lens may make noticeable differences in your visual outcome, maximizing their benefits. A laser will offer the best possible lens alignment. If you have astigmatism, the laser can be used to correct astigmatism, with or without the use of toric IOLs. However, your pupil must be able to achieve adequate dilation and you must be able to lie flat on your back to have laser-assisted cataract surgery.

Beyond Vision Restoration

Due to advances in technology, cataract surgery offers more benefits than ever. Modern IOLs can help patients see better than they could even before cataracts, and laser-assisted surgery makes the procedure even more precise and less likely to result in collateral damage. If you are considering cataract surgery, talk to your ophthalmologist about what you’d like to achieve through your surgery and whether laser-assisted surgery might be beneficial for you.

More About Cataract Specialist Shunai Jiang, M.D., Ph.D.

Dr. Jiang is an ophthalmologist at the Marietta Eye Clinic who specializes in cataracts and glaucoma. She serves the Kennestone, Canton, and East Cobb locations. Dr. Jiang studied at Jilin University in China and the Karolinska Institute in Sweden, the home of the Nobel Prize in Physiology or Medicine. She received her residency training in ophthalmology from the University of Louisville and fellowship training in glaucoma from Emory University. She is a member of the American Academy of Ophthalmology and the American Glaucoma Society. Read her full bio here.

References and Additional Resources

The American Academy of Ophthalmology (AAO) is the world’s largest association of eye physicians and surgeons. It describes itself as a “global community of 32,000 medical doctors who protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public.” Its website is a great resource to learn more about how to care for your eyes.

The American Optometric Association (AOA) describes itself as the leading authority on quality care and an advocate for our nation’s health, representing more than 44,000 doctors of optometry, optometric professionals, and optometry students.

High-Tech Toric IOL Axis Alignment

https://www.aao.org/eyenet/article/high-tech-toric-iol-axis-alignment

Traditional Cataract Surgery vs. Laser-Assisted Cataract Surgery

https://www.aao.org/eye-health/diseases/traditional-vs-laser-assisted-cataract-surgery

MD Roundtable: 3 Femto Surgeons Discuss Their Perspectives and Insights on FLACS

https://www.aao.org/eyenet/article/md-roundtable-3-femto-surgeons-discuss-their-persp

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