By Dr. Mark Siegel
Are you planning to have cataract surgery? If so, you may be offered a choice of two surgical options: traditional manual cataract surgery or laser-assisted cataract surgery.
Traditional cataract surgery is one of the most common surgeries in the world. It is recognized as being safe and effective.
Laser cataract surgery, which is not covered by insurance plans, costs more than traditional cataract surgery but provides some advantages in terms of precision and accuracy — in the proper situation.
So how do you decide which type of cataract surgery to have?
Here are some things you should understand about both kinds of cataract surgery. Talk with your ophthalmologist to determine the best type of surgery for you.
Traditional cataract surgery
With traditional cataract surgery, called phacoemulsification, the eye surgeon creates a small incision in the side of the cornea by hand with a scalpel blade.
An instrument is inserted through this incision into the area behind the pupil where the eye’s lens sits in a capsule or bag. The surgeon uses a cystatome (bent needle) instrument to create a circular opening in the lens capsule. Then a special pen-shaped probe is inserted through that opening to apply sound waves (ultrasound) to break up the cloudy center of the lens.
Then the broken-up pieces of lens are suctioned out of the eye. An artificial intraocular lens (IOL) is implanted to replace the cloudy natural lens.
The side walls of the corneal incision will be filled with a special liquid and self-seal after surgery, so most commonly stitches are not needed.
Laser-assisted cataract surgery
With laser-assisted cataract surgery, a camera/ultrasound imaging device (OCT) is placed over your eye to map its surface and gather information about the lens.
The device sends detailed information to a computer that programs the laser for the exact location, size and depth of the incisions.
The surgeon uses the laser to make the corneal incisions, especially astigmatic incisions, and the opening in the lens capsule.
Energy from the laser is also used to soften the cataract into fragments. Then the ultrasound probe used in traditional cataract surgery is used to gently suction them out of the eye. The IOL is implanted.
As with traditional cataract surgery, the corneal incision usually does not require stitches.
What’s best for you
Under today’s Medicare guidelines, only certain patients may be offered laser-assisted cataract surgery.
Specifically, your ophthalmologist can offer it if you have astigmatism diagnosed during your cataract consultation and would like to have that refractive error corrected during cataract surgery.
In this situation, the laser is used to create specific incisions, called limbal relaxing incisions in the cornea to reshape it, treating the astigmatism.
You may also be offered laser cataract surgery if you choose to have a premium lens implanted, such as an astigmatism-correcting toric IOL or a multifocal IOL.
Ophthalmologists who use laser cataract removal technology recognize that it allows them to see and map the lens capsule better and place the opening in the capsule more precisely, allowing for better centering and placement of the IOL.
Can you choose to have laser-assisted cataract surgery if you don’t have either of the conditions above?
Current Medicare guidelines say that a surgeon may not offer and charge for the laser-assisted cataract surgery unless one of the two conditions above is met.
Recovery from surgery
The recovery period for both laser-assisted cataract surgery and traditional cataract surgery is the same.
Some people can see clearly almost immediately, while others may find their vision clears within about a week or two.
Studies have shown that laser cataract surgery reduces the amount of ultrasonic energy required to break up the cataract which may reduce post-operative swelling.
Remember that it takes about three months to fully recover from cataract surgery.
Benefits of surgery
What benefits does laser cataract surgery offer that traditional cataract surgery does not?
Using a laser to do cataract surgery allows the surgeon to make very precise incisions in less time. It can improve accuracy and precision in the surgical steps. And laser-assisted cataract surgery can provide a higher degree of correction for a refractive error, such asastigmatism, than traditional cataract surgery.
However, it is important to be aware that studies have not shown that laser-assisted cataract surgery results in fewer complications or better visual outcomes than traditional cataract surgery.
With any type of cataract surgery, your outcome depends in large part on the skill and experience of your eye surgeon.
For some people, simply replacing a cloudy lens with a clear implant and wearing glasses for some activities is perfect. For others, achieving the best possible vision without glasses after cataract surgery is the goal.
Your vision needs and expectations can help you and your ophthalmologist decide the best surgical option for you.
Dr. Mark Siegel is the medical director at Sea Island Ophthalmology at 111 High Tide Drive (off Midtown Drive near Low Country Medical Group). Visit www.seaislandophthalmology.com.
