The Experts Weigh In On Laser Cataract Surgery
News Three leading Canadian ophthalmologists weigh in on important questions regarding laser cataract surgery, the most common eye surgery.
What are the benefits of laser cataract surgery?
Sheldon Herzig: The main benefit of Laser Cataract Surgery is to improve safety and add precision to the procedure. Typically, cataracts are removed by breaking them up with ultrasound energy. By softening the cataract with the laser prior to removing it, little or no ultrasound energy is required inside the eye, thereby making the procedure safer. This is especially true for more difficult, complicated cataracts.
Raymond Stein: Laser surgery allows surgeons to automate a number of the critical steps of the procedure, to enhance safety and improve outcomes. In traditional cataract surgery, surgeons utilize a blade, needle, chopper, or other handheld instruments. In laser cataract surgery many of the most important steps are automated under computer control. Automated steps include the corneal wound incisions, reduction of astigmatism, central opening in the cataract, and fragmentation of the cataract into small pieces before removal. These automated steps make the surgery easier for surgeons and can lead to enhanced outcomes.
Allan Slomovic: Cataract surgery has gone through tremendous evolution and sophistication in the past decade and has become a safer, more effective procedure. The newest introduction is femtosecond. The main benefit of this laser is that it can make the incision 100% reproducible with precision that can’t be duplicated by hand. The other main advantage is that it breaks up the cataract within the eye so that less phaco energy needs to be used to take out the cataract.
How can patients expect to have better vision after laser cataract surgery?
Sheldon Herzig: Using the laser makes the various steps in the cataract operation more precise. This is particularly true for making the capsulorhexis, the round opening in the front surface of the cataract. The visual benefit of this precision for the patient is to improve the stability of the intraocular lens that is inserted, thereby reducing visual fluctuations that can occur with changes in intraocular lens position.
Raymond Stein: The laser can create a perfectly round central opening in the cataract close to 100 percent of the time. The remaining anterior capsule holds the intraocular lens in place. This consistent capsule overlying the edge of the implant decreases the risk that the implant will vault forward, backward, or be tilted. This has been shown to improve the quality of vision by decreasing what is referred to as ‘higher-order aberrations’, and the refractive accuracy of the procedure.
Allan Slomovic: When opthalmologists do an operation, the main reason for doing the operation is to improve vision. Every operation has some risk, which must be discussed with the patient, but the main goal of cataract surgery is to improve the patient’s vision post operatively, whether that’s done with femtosecond or standard techniques.
Provincial health plans don’t cover the costs for the laser portion of cataract surgery. Is it worth the added cost?
Sheldon Herzig: Provincial health plans can’t keep up with the rapid changes in technology that improve surgical outcomes. Our eyes are priceless and I believe it is worth any extra cost to have a cataract removed in the safest and most precise manner. If I needed cataract surgery today, I would certainly want my surgeon to use the laser as part of the procedure.
Raymond Stein: The short answer is “yes” from an individual patient’s perspective. However, from the standpoint of society, no government has an open-ended budget. Every field of medicine and surgery is progressing at a faster rate than we have ever witnessed. Every patient would like to have all procedures or medications totally covered. This is certainly not possible without affecting other areas of public service. The decision for coverage will be up to elected politicians in consultation with doctors to determine the best strategy going forward.
Raymond Stein: There are certain things that aren’t covered by health care, and these are quality of life issues. If you want to have things like a multifocal lens, or the ability to correct astigmatism with a lens inside the eye, there are additional costs. Options should be discussed with patients, and it is paramount that they are given the choice. It’s in our patient’s best interest that these new advances are incorporated as an option. That speaks to good patient care.