Understanding Laser Cataract Surgery
“So Doc, you’re gonna use a laser to do my cataract surgery, right?” It turns out this question is quite common coming from my patients, and my answer is… it depends! So before getting to that, it’s helpful to back up a step or two and address a few more basic questions regarding cataracts and cataract surgery.
First off, what exactly is a cataract?
“Cataract” is the term used to describe a clouding of the natural lens, the focusing element inside the eye which functions much like the lens of a camera. Cataracts are an inevitable aging change of the eye. Indeed, if you live long enough you’re likely to at some point develop cataracts. While the majority of patients undergoing cataract surgery are over the age of 60, there is no “right age” for cataract surgery; whenever they’re ready, they’re ready!
Cataract surgery itself is basically a two-step procedure; the cloudy cataract is removed and a clear artificial lens is then implanted. Cataract surgery has evolved over time from a somewhat barbaric procedure fraught with relatively frequent complications into a true miracle of modern medicine. The development of phacoemulsification in the late 1960’s ushered in the modern era of cataract surgery and by the 1990’s small-incision cataract surgery utilizing “phaco” had become the procedure of choice for cataract removal. Not much changed until the early 2010’s when femtosecond laser technology, previously used for LASIK, began to be utilized in cataract surgery. Now a decade following its initial introduction, femtosecond laser-assisted cataract surgery (or “FLACS”) has become a popular choice for both premium surgeons and patients seeking the most technologically advanced procedure available for cataract removal.
To understand how FLACS contributes to exceptional surgical outcomes, it’s helpful to have a basic understanding of astigmatism as well as the essential surgical steps in cataract removal. Astigmatism is the term used to describe a non-spherically shaped cornea (the clear window on the front of the eye). Why does astigmatism matter in cataract surgery? Because the light rays heading through the eye toward the retina must first pass through the cornea. When the cornea is shaped more like a football (astigmatism) instead of a basketball (spherical) the image will be distorted as it passes through the eye. Astigmatism is usually corrected with glasses or contact lenses, but for a patient with cataracts, astigmatism is best managed at the time of surgery via an astigmatic-correcting procedure. Utilizing the femtosecond laser, a premium surgeon is able to create extremely precise incisions into the cornea for the reduction of low-to-medium levels of astigmatism to achieve the best possible vision without glasses.
Two of the more challenging steps of cataract removal are the creation of the capsulotomy and the breakdown of the cataract itself into smaller pieces. The femtosecond laser is used to perform these delicate steps with a precision unable to be matched with conventional cataract surgery. The capsulotomy is the initial opening into the cataract and unfortunately in some cases its creation by hand can go awry. In FLACS, a perfectly-sized and centered capsulotomy is created allowing the remainder of the surgery to proceed smoothly. Additionally, a well-sized and centered capsulotomy helps ensure ideal placement of the lens implant towards the conclusion of the surgery. The femtosecond laser also initiates and augments the fragmentation of the cataract itself. By “pre-chopping” the lens into smaller pieces, this sometimes complicated step is streamlined and the ultrasound energy required to remove the cataract is reduced. The result: a quicker recovery and a better chance at achieving that early “wow” factor loved by both the patient and the surgeon alike.
So, getting back to our initial question regarding whether to use laser for cataract surgery, my answer for most patients is a resounding “YES, I highly recommend it!” Patients must know, however, that with premium surgery does come additional out-of-pocket expenses. At Florida Medical Clinic Eye Specialists, we strive to ensure every patient who wishes to take advantage of the opportunity for advanced technology premium cataract surgery has the chance to do so while knowing ahead of time their expected out of pocket costs. If you or a loved one are interested in learning more, please visit our website at fmc2020.com and click on the “Premium Cataract Surgery” tab.
About Mark L. Arey, MD
Dr. Arey is a board-certified ophthalmologist and specialist in premium cataract surgery at Florida Medical Clinic Eye Specialists with offices in Tampa and Land O’ Lakes. Dr. Arey graduated from the University of Virginia and Wake Forest University School of Medicine. He completed his ophthalmology residency and fellowship at the University of Texas Southwestern Medical Center/ Parkland Memorial Hospital in Dallas.
Dr. Arey is a husband and the father of three great kids and has coached hundreds of Tampa Bay area youth in soccer, basketball, and baseball over the past decade. Amongst several other professional societies, Dr. Arey is a member of the American Society of Cataract and Refractive Surgeons (ASCRS). He recently earned a certificate for completing the ASCRS 2020 Master Class in Refractive Cataract Surgery, an eighteen-hour course covering all-things related to premium cataract surgery.
Please visit fmc2020.com for more information about Dr. Arey and the FMC Eye Specialists practice, and please follow Dr. Arey on Facebook, Instagram, and YouTube @drmarkarey. Dr. Arey and his staff are very excited to be moving into a brand-new office in North Tampa in the Spring at 14014 N. 46th Street, Suite A , and can be reached at 813-284-2323.