Deciding Between Traditional and Laser-Assisted Cataract Surgery by Denise Johnson, M.D.

March 17, 2020

Dr. Johnson is an ophthalmologist and cataract specialist at the Marietta Eye Clinic.

Vision loss due to cataract is reversible. In the early stages of cataracts, your ophthalmologist will monitor the progression, updating your prescription for glasses or contacts along the way. When your lenses become so clouded that updates to your prescription no longer help, surgery is the only treatment option. During cataract surgery, the cloudy lens is removed and an artificial lens, called an intraocular lens (IOL), is implanted. There are two methods of doing this. You can opt for traditional cataract surgery or laser-assisted cataract surgery. But how do you choose?

Traditional Cataract Surgery

Traditional cataract surgery is performed manually with a surgical blade. An ophthalmologist makes two small incisions in your cornea. The eye is filled with a viscous material that helps to maintain the natural volume of the eye. The capsule, the bag that contains your cataract, is opened. An ultrasound handpiece is used to break up the cataract. The handpiece has a vacuum that aspirates the pieces of your cataract. An intraocular lens is inserted in the same capsule that contained your cataract. The incision may or may not require stitches.

Traditional cataract surgery is one of the most commonly performed surgical procedures in the world. It is universally recognized as being both safe and effective.

Laser-Assisted Cataract Surgery

In laser-assisted cataract surgery, the laser is used to correct corneal astigmatism, create the circular opening in the capsule, and softens the cataract. The laser can also create the corneal cataract incisions. Removal of the cataract is still done by the ophthalmologist. The incision may or may not require stitches.

What are the Differences?

Laser-assisted surgery is more precise. This allows eye surgeons to treat your corneal astigmatism, which allows for more spectacle independence. Because a laser can be used to soften the cataract, less ultrasound energy is needed to break it up, which decreases the risk of swelling of the cornea. Laser-assisted surgery also provides for a safer surgery in patients who have a weak zonules, which are the support structures for the cataract.

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

Only certain patients qualify for laser-assisted cataract surgery, as regulated by Medicare. At this time, you may qualify for 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.

With premium IOLs, use of a laser might be recommended because the alignment of the lens may make noticeable differences in your visual outcome. 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.

Cataract Surgery: More Than Just Lens Replacement

Due to advances in technology, cataract surgery offers more benefits than ever. Modern intraocular lenses can help patients see better than they could even before cataracts, and laser-assisted surgery allows for more precision. 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 Denise Johnson, M.D.

Dr. Johnson is an ophthalmologist at the Marietta Eye Clinic who offers comprehensive care and specializes in cataracts, dry eye, and cosmetic treatments. She serves the Acworth and Towne Lake locations. She is board-certified by both the American Board of Ophthalmology and the American College of Lifestyle Medicine. She received her undergraduate degree from Cornell University and her medical degree from the Temple University School of Medicine. She is professionally associated with the American Academy of Ophthalmology, the American Society of Cataracts and Refractive Surgeons, the American College of Lifestyle Medicine, and the Physician’s Committee for Responsible Medicine. 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 (O.D.), optometric professionals, and optometry students.

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