Deciding if Laser-Assisted Surgery is Right for You by Jeffrey Tran, M.D.

August 14, 2020

Dr. Jeffrey Tran is a comprehensive ophthalmologist and cataract surgeon at the Marietta Eye Clinic.

Cataracts, which naturally occur with age, cause vision changes and eventually even vision loss. In the early stages of cataracts, your ophthalmologist will likely want to monitor the progression, possibly updating your prescription for glasses or contacts along the way. When your lenses become so clouded that updates to your prescription no longer offer relief from cataracts, your doctor will likely discuss surgery to remove your cataract. During cataract surgery, the clouded lens is removed and an artificial replacement lens, called an intraocular lens (IOL), is implanted. There are two methods of cataract surgery. You can opt for traditional cataract surgery or laser-assisted cataract surgery. So how do you decide?

Traditional Cataract Surgery

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

Laser-Assisted Cataract Surgery

In laser-assisted cataract surgery, a camera or ultrasound device is used to map the surface of your eye and get information about your lens and that information is sent to the laser. The laser is then programmed with the exact size, depth, and location of incisions to be made during surgery. The laser first softens the cataract, and then, similar to traditional cataract surgery, a probe uses sound waves to break it up into smaller pieces once in the operating room. Finally, the pieces of the cataract are removed and the IOL is inserted by the surgeon. The incisions usually do not require stitches.

What are the Differences?

Laser-assisted surgery is very precise, allowing eye surgeons to make incisions at the ideal locations and depths based on your eye measurements. This also helps your eye surgeon center the IOL as much as possible. Because a laser can be used to soften the cataract, less sound wave energy is needed to break it up, which may reduce heat built up in the incision and further reduce complications. In many cases, laser-assisted surgery can be performed more quickly than traditional cataract surgery.

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?

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.

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.

Cataract Surgery: More Than Just Lens Replacement

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 with less 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 Surgeon Jeffrey Tran, M.D.

Dr. Tran is a comprehensive ophthalmologist and cataract surgeon at the Marietta Eye Clinic. Dr. Tran earned his medical degree from Emory University School of Medicine and completed a residency at Cullen Eye Institute at the Baylor College of Medicine. He is a member of the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the Association for Research in Vision and Ophthalmology, the American College of Physicians, and the American Medical Association. Read more about Dr. Tran 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. 

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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