Today I would like to answer a question that I often get from my patients
before their cataract surgery. What is the Difference between
laser-assisted cataract surgery conventional cataract surgery? and we will also discuss that how does
femtosecond laser works and how does it assist in each surgical step
during cataract surgery.
Now you and your family members may have been
diagnosed with cataracts and recommended to have cataract surgery and the
surgeon offered you options of having either
laser-assisted cataract surgery or conventional cataract surgery
which one should you choose? To answer that question first let’s talk
about How Does Fentanyl Second Laser Work?
Difference Between Laser Cataract Surgery and Conventional Cataract Surgery
During laser system cataract surgery the type of laser we use is called a
femtosecond laser. It is called a
femtosecond laser it’s
because each laser pulse only lasts a few hundred femtoseconds.
each
femtosecond equals 10 to the minus 15th of a second, the femtosecond laser
can fire thousands of laser pulses each second to separate the tissue
smoothly and continuously to create incisions, and both the location and the
pattern of incisions are programmed by the surgeon using an
image-guided laser system and it is highly customizable my patients
often also ask me dr. Ruman if I choose to have laser system cataract
surgery is it painful? Can I feel the laser pulses?
fortunately, the answer is no. The phantom second laser portion of
the cataract surgery only lasts just a few minutes and during this portion
of the surgery.
The eye is anesthetized with eye drops so you won’t
be able to feel the laser pulses but you may be able to see different
colors of lights. It’s almost like a light show that being said let’s
talk about how femtosecond laser assists each surgical step. Cataract
surgery has four major surgical steps;
- Corneal incision
- Capsulorhexis
- Cataract Fragmentation and Removal
- Intraocular lens insertion
Contents
1. Corneal Incision
The corneal incision is the first surgical step when the surgeon gains
access into the eye through incisions on the
cornea. During
conventional cataract surgery, the surgeon uses a very
small blades usually between two to three millimeters in width to
create incisions during laser is the cataract surgery.
The incisions size
is programmed by the surgeon using an image-guided laser system and
then the femtosecond laser creates the incisions in just a few seconds.
Not only the location and the size of the corneal incision are highly
customizable. The femtosecond laser can also create
arc-shaped incisions on the cornea to treat astigmatism and
to improve uncorrected vision after surgery.
2. Capsulorhexis
the next surgical step is capsulorhexis and it is the most crucial
surgical step during cataract surgery. The capsule is a very
thin tissue with an
average thickness of seven microns and it wraps around the cataract.
Capsulorhexis is the step where the circular opening is made on the
capsule and the surgeon has to gain access to the cataract through the
circular opening
of capsulorhexis. Both the shape as well as the position of capsulorhexis
can affect where the intraocular lens sits in the eye and can
affect vision after cataract surgery.
Therefore it is very important to create capsulorhexis that’s perfectly
centered and as circular as possible during conventional cataract surgery.
The surgeon creates the capsulorhexis with a very fine
instrument manually during laser-assisted cataract surgery.
The
position and the size of capsulorhexis are programmed by the surgeon using
an image-guided laser system and the femtosecond laser creates the
capsulorhexis in a second that you can see as a surgeon.
I can see both the position and the size capsulorhexis where exactly I want
it to be in my experience. I found that the saturation of the
intraocular lens is often improved with femtosecond laser
capsulorhexis.
3. Cataract Fragmentation and Removal
The next surgical step is cataract fragmentation and removal. This is the
step the cataract is fragmented and removed from the eye.
During conventional cataract surgery, the surgeons use a very small
instrument called a chopper to disassemble the cataract and remove
the cataract from the eye by using phacoemulsification.
Phacoemulsification means using ultrasound energy to break down the
cataract and remove it from the eye.
Durin laser system cataract surgery the cataract is fragmented into
different sizes and shapes of smaller fragments by laser designed by the
surgeon based on the surgeon’s preferences.
During this step, it is
very important to minimize the amount of time, as well as
ultrasound energy used during phaco as increased
vehicle time and ultrasound energy used during cataract surgery, are
related to increased tissue damage that occurs during surgery.
More tissue damage occurred during surgery can result in increased recovery
time after surgery for vision.
4. Intraocular Lens Insertion
The next surgical step is the intraocular lens insertion. During this step
both conventional cataract surgery as well as laser-assisted cataract
surgery, the surgeon inserts the intraocular lens into the
capsular bag through the capsular opening made during
capsular rexes. Both the position as well as the centration of the
intraocular lens can affect vision after cataract surgery.
If the intraocular lens sits just half a millimeter too forward or backward
in the capsular bag. It can result in big differences in glass prescription
after cataract surgery.
As I mentioned before both the position and the
shape of the capsulorhexis can affect the position of the intraocular lens.
Now we have discussed the differences between laser-assisted cataract
surgery versus conventional cataract surgery and how femtosecond laser
assists each surgical step.
I hope this article helps you to understand those differences and you are
more prepared when having a conversation with your eye surgeon about your
surgical plan.
As always please remember cataract surgery has risks just
like other types of surgery. Please discuss with your eye surgeon about any
specific questions that you may have about your vision and your eye
surgery.
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