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What is the Femtosecond Laser? by Amy Cherof, M.D.

February 19, 2020

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

Cataracts occur when the lens in your eye becomes clouded. Around age 40, proteins in the eye start to break down. By age 60, most people experience clouding of the lenses, although symptoms may not be noticeable at first. If cataracts progress to the point that they limit a patient’s day to day activities or quality of life, an ophthalmologist may perform cataract surgery, a procedure in which the cloudy lens is removed and replaced with an artificial intraocular lens. Thanks to modern technology and the femtosecond laser, cataract surgery is safer and more effective than ever. Marietta Eye Clinic has a team of cataract specialists highly skilled at performing eye surgery with the assistance of the femtosecond laser.

What is It?

A femtosecond laser is an infrared laser that emits bursts of laser energy at an extremely fast rate. A femtosecond laser has a pulse duration in the femtosecond range, or one quadrillionth of a second. Although it was originally introduced in ophthalmology for use in LASIK eye surgery, femtosecond lasers have become widely used in a variety of eye surgeries and have become a preferred tool in many surgical eye procedures.

The History of the Femtosecond Laser

The femtosecond laser was introduced in the U.S. in the early 1990s and developed by Dr. Kurtz at the University of Michigan. It was approved in 2001 by the U.S. Food and Drug Administration for use in laser-assisted in situ keratomileusis, or LASIK eye surgery. In LASIK, the femtosecond laser is used on the cornea to create a corneal flap. Underneath that flap, the eye can be reshaped, and the flap serves to protect the eye as it heals.

Since then, the technology has dramatically improved. Newer models of femtosecond lasers have an increased pulse frequency. Less energy is released in current femtosecond laser technology so that less tissue surrounding the target area is affected. These models are more energy efficient than previously introduced models and procedures can now be completed more quickly. Today, the femtosecond laser is used in a variety of ophthalmologic surgeries and advancements continue to be made.

How Does the Femtosecond Laser Work?

In laser-assisted surgery, tissue is broken apart at the molecular level rather than cut with a blade. The femtosecond laser disrupts stromal tissue through a process known as photoionization. Targeted tissue is vaporized, creating a split where a cut would normally be made.

What are the Benefits of Using a Femtosecond Laser?

A femtosecond laser has been proven in studies to offer more precise incisions with less damage to the surrounding tissue compared to those made with a blade. Studies show femtosecond lasers, compared to blades, cause fewer complications and that patients heal faster post-surgery. A femtosecond laser also has the benefit of greater consistency and more versatility. Compared to an Yttrium-Aluminum Garnet (YAG) laser, another commonly used ophthalmic laser, a femtosecond laser causes less collateral damage — 106 times less damage, in fact. Benefits of femtosecond laser assisted cataract surgery include ability to provide more precise astigmatism treatment (via arcuate keratotomies), centration of the intraocular lens, and decreased ultrasound energy utilized during removal of the cataract. The unique properties of femtosecond lasers have led to many advances in surgical techniques as they have become more widely adopted.

Which Procedures Benefit From the Femtosecond Laser?

The femtosecond laser was approved for refractive and cataract surgery by the U.S. Food and Drug Administration in 2015 and is considered a relatively new development in the history of cataract surgery. A femtosecond laser can also be used for other ophthalmic procedures such as laser in situ keratomileusis (LASIK), penetrating keratoplasty, and other types of corneal transplants.

Cataract becomes extremely common with age. The National Eye Institute found that by age 80, cataract was present in greater than 68% of the population in the U.S. For this reason, cataract surgery is one of the most common surgeries performed in the U.S. and many other developed countries.

More About 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 high honors with her undergraduate degree and 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.

FDA approves laser for refractive and cataract surgery

https://www.aao.org/headline/fda-approves-laser-refractive-cataract-surgery-2

Femtosecond lasers and laser assisted in situ keratomileusis (LASIK)

https://eyewiki.aao.org/Femtosecond_lasers_and_laser_assisted_in_situ_keratomileusis_(LASIK)

Femtosecond Cataract Surgery

https://eyewiki.org/Femtosecond_Cataract_Surgery

Femtosecond lasers and laser assisted in situ keratomileusis (LASIK)

https://eyewiki.aao.org/Femtosecond_lasers_and_laser_assisted_in_situ_keratomileusis_(LASIK)

The evolution of corneal and refractive surgery with the femtosecond laser

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655461/

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