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How to Decide if Laser-Assisted Surgery is Right for You by Amy Cherof, M.D.

March 12, 2020

Dr. Cherof is an ophthalmologist and cataract surgeon at the Marietta Eye Clinic.

Vision loss due to a cataract is a progressive process. While your ophthalmologist may monitor your cataracts initially, when they become so clouded that your vision negatively affects your day-to-day activities, surgery is the only treatment option. During cataract surgery, the cloudy lens is removed and an artificial lens is implanted. There are two methods to perform this procedure. You may opt for traditional cataract surgery or laser-assisted cataract surgery. The following information can help you decide which method is better for you.

Traditional Cataract Surgery

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.

Traditional cataract surgery is performed manually with a surgical blade. Small incisions are made in your cornea, and an opening is created in the capsule where your natural lens resides. A surgical ultrasound probe is inserted into the eye, and ultrasound energy is used to emulsify, or break up, the cataract. These small pieces of the natural lens are then removed, and a replacement artificial lens referred to as an intraocular lens (IOL) is inserted. The incision typically self-seals and does not require stitches.

Laser-Assisted Cataract Surgery

In laser-assisted cataract surgery, a highly magnified camera or ultrasound device is used to map both the surface of the eye as well as the inside compartment of your eye, including the lens. This information is used to program the laser with the exact size, depth, and location of laser energy to be applied. First, the laser can be used to perform the corneal incisions on the ocular surface. Second, the laser will make a precisely sized opening in the capsular bag that is optimally located and centered. Third, the laser will be used to soften the cataract. Fourth, the laser can treat the cornea with small incisions to minimize the amount of residual astigmatism present after surgery. Next, similar to traditional cataract surgery, ultrasound energy is used by the surgeon to break up and remove the cataract so that the IOL can be inserted. The incision typically self-seals and does not require stitches.

What are the Differences?

Laser-assisted surgery is more precise than traditional cataract surgery. Mapping the eye allows surgeons to make incisions at the ideal locations for your eye and better center the IOL. The more precise the incisions, the better the incision will be able to self-seal, reducing risk of infection. The better centered the IOL, the better chance of optimal vision after surgery. Because the laser is first used to soften the cataract, less ultrasound energy is required to break it up. The benefits of decreased ultrasound energy include reduced corneal edema and intraocular inflammation, both of which can delay healing or recovery of vision. Additionally, treatment of astigmatism can result in a better visual outcome with sharper focus.

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

Only certain patients qualify for laser-assisted cataract surgery, as per Medicare. At this time, you may qualify for laser-assisted surgery if you meet one of the following conditions:

  • You choose a premium IOL — that includes accommodative, multifocal, or toric lenses — or
  • You have astigmatism and choose to have it corrected during surgery.
  • Additionally, your pupil must achieve adequate dilation, and you must be able to lay flat on your back for the procedure.

Cataract Surgery: More Than Just Lens Replacement

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

More About Cataract Specialist Amy Cherof, M.D.

Dr. Cherof is an ophthalmologist with the Marietta Eye Clinic who specializes in cataracts in addition to offering comprehensive care. She serves the Kennestone, West Cobb, and Windy Hill locations. Dr. Cherof graduated summa cum laude with highest honors with her undergraduate degree from the University of Georgia. She received her medical degree from the Augusta University Medical College of Georgia. She is a member of the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, and the Georgia Society of Ophthalmology. 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.

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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