Lasers, they’re everywhere. From barcode scanners and hair removal to superhero vision and spy gadgets, lasers have a thousand and one applications (probably more). They’re also pretty useful when it comes to cataract surgery.
What are Cataracts?
First things first, what are cataracts? A cataract is a clouding or opacity of the lens inside the eye. Since light needs to be able to pass through this lens for us to see the world around us, any haze in this structure can result in the typical symptoms of cataract, including:
- Blurred vision
- A filmy sensation to your sight, often described as like looking through a dirty window
- Increased glare sensitivity, particularly at night
- Reduced contrast sensitivity, such as when trying to read in dim lighting
- Frequent glasses or contact lens prescription changes, due to the progressing cataract altering the refractive power of the lens
Cataracts are not dangerous and if you choose to leave them be for a while, they’re not likely to do you any harm (other than not being able to see properly).
The only definitive treatment for cataracts at this point in time is through surgical extraction. A temporary fix may include updating your glasses to keep up with the prescription change, but this can become quite costly over time and at some point, will stop being a useful solution.
Femtosecond Laser-Assisted Cataract Surgery: What is It?
Commonly abbreviated to FLACS, femtosecond laser-assisted cataract surgery is a modern form of cataract surgery using – you guessed it – a femtosecond laser. Although it sounds a little more impressive than phacoemulsification cataract surgery by virtue of the word laser, both forms of cataract surgery are considered safe and effective and are still commonly used in modern ophthalmology.
The femtosecond laser is a medical device that produces a very, very short pulse of near-infrared energy. This pulse is 10-15 seconds long, which allows the cataract surgeon (and you) to avoid heat-related complications.
Conventional cataract surgery with phacoemulsification involves:
- Anesthetizing the eye
- Creating a small incision in the front surface of the eye (cornea) using a handheld scalpel
- Opening the capsule containing the cloudy lens using another handheld instrument inserted through the corneal incision, a step known as a capsulotomy
- Applying an ultrasound probe to the lens, using soundwaves to fragment the lens into small pieces
- Suctioning out these pieces
- Replacing the extracted lens with your intraocular lens (IOL) of choice, such as an extended depth of focus IOL
- Allowing the corneal incision to self-seal
FLACS follows all of these same steps, except it uses the femtosecond laser to:
- Create the corneal incision
- Perform the capsulotomy
- Fragment the lens
See? One laser, many applications.
Benefits and Limitations of Femtosecond Laser-Assisted Cataract Surgery
When compared to using a handheld instrument, the advantages of a computer-guided laser are obvious. FLACS demonstrates a superior level of precision, accuracy, predictability, and efficiency compared to conventional phacoemulsification.
Visual outcomes
However, despite FLACS winning gold medals for precision, accuracy, predictability, and efficiency, studies do not show any significant benefit in long-term visual results between FLACS and phacoemulsification. In fact, FLACS is more likely than phacoemulsification to result in a common but harmless complication after cataract surgery known as posterior capsular opacification (PCO). PCO occurs due to a proliferation of cells left in the lens capsule, leading to a secondary clouding of the IOL which can be easily zapped off with a laser (so many laser applications!) in the doctor’s office.
Complications
Are FLACS and phacoemulsification equally safe? The risk of complications seems to be comparable between FLACS and phacoemulsification with a few exceptions. The lower energy used by the femtosecond laser for the lens fragmentation step compared to the ultrasound probe may protect cell loss in patients with vulnerable corneas, such as those with Fuchs’ endothelial dystrophy. Similarly, patients with macular disease are less likely to experience inflammation and swelling of the macula when treated with FLACS compared to phacoemulsification.
Costs
The technology behind FLACS is more expensive than the equipment needed for phacoemulsification, with these higher costs mostly passed on to the patient. In addition to the cost of the femtosecond laser technology, an eye surgeon still needs the phacoemulsification equipment to complete the suctioning step of the cataract surgery procedure.
Which Should You Choose?
After a comprehensive exam with your cataract surgeon, you will have a better idea of whether FLACS may be more suitable for your situation compared to phacoemulsification (and whether your cataract surgeon offers FLACS at all).
FLACS may be better if you have a co-existing eye disease or complexity, such as a corneal dystrophy, complicated cataract, or macular disease. If none of these considerations apply to you, conventional cataract surgery could be a reasonable choice, and not to mention easier on the wallet.