Traditional Phacoemulsification Vs Femtosecond Laser-Assisted Cataract Surgery

Cataract surgery is one of the oldest and most reliable eye care procedures. Over the past decade the surgery has seen advances in technology intended to improve the outcome for patients.

One of these advancements is called femtosecond laser-assisted cataract surgery (or FLACS). Approved by the FDA in 2010, FLACS represents a more precise form of the procedure intended to rely less on manual techniques.

Both FLACS and traditional cataract surgery (known as phacoemulsification surgery) have distinct advantages and disadvantages. To make safe and informed choices about their eye care, patients should understand a few key details about both procedures.

A cataract is an ocular condition where the lens inside of the eye has become cloudy and hardened over time, allowing less and less light to enter. This gradual clouding causes vision to dim and blur, making it difficult for patients to perform daily activities.

During cataract surgery, a surgeon removes a patient’s cloudy lens and replaces it with an artificial or intraocular lens (IOL). This clear lens allows the patient to enjoy clearer vision.

Traditional (also known as phacoemulsification) surgery is currently the most widely performed cataract surgery. During the procedure, the ophthalmologist replaces a patient's clouded lens with a new artificial lens. Patient’s can think of it like implanting a contact lens into their eye to improve their vision.

In traditional cataract surgery the eye doctor uses a blade or scalpel to make a small incision in the front of the eye. They then make a circular cut in the lens and use ultrasound waves to break up the cataract and insert a new artificial lens.

Femtosecond laser-assisted cataract surgery (FLACs) is a relatively new type of cataract surgery where the ophthalmologist utilizes femtosecond lasers. First used in LASIK, femtosecond lasers allow surgeons to cut through eye tissue with greater speed and accuracy.

During the procedure, a surgeon uses a femtosecond laser to make an initial incision in the eye. The laser is then used again to access and break up the cataract into smaller pieces.

From there, the surgeon softens and removes the cataract with an ultrasound—similar to traditional surgery. A circular opening is created to remove the cloudy cataract and replace it with a new lens.

Traditional cataract surgery is performed manually by the surgeon. The ophthalmologist manually makes an incision in the cornea and creates a circular opening to remove the cataract.

FLACS replaces much of the manual work with a femtosecond laser which is used to perform key steps in the procedure.

Steps that rely on the femtosecond laser can include:

• Creating the corneal wound to enter the eye

• Making a circular opening on the surface of the cataract for cataract removal

• Breaking up the cataract into smaller pieces

• Additional corneal cuts to reduce astigmatism

Advocates of FLAC believe that using a femtosecond laser is faster and more precise than the manual process used in traditional surgery.

Femtosecond laser cataract surgery is a newer and more advanced form of the procedure. It has a few advantages that patients should be aware of:

Advocates of femtosecond laser cataract surgery believe the procedure is more precise than traditional cataract surgery. The femtosecond lasers used in the surgery allows doctors to make more precise incisions.

Surgeons can also use 3D mapping and imagining to develop a more complete view of the patient's eye. This allows them to make more accurate incisions and enables them to better position artificial lenses in the eye.

In femtosecond laser cataract surgery doctors can reshape patients corneas more precisely to reduce astigmatism (an irregularly shaped cornea).

This also allows patients to select Toric lens implants which correct for astigmatism. Both these options can make this surgery a more appealing choice for patients with astigmatism.

Femtosecond laser assisted cataract surgery requires less ultrasound to break up the cataract. This can lead to a reduced risk of complications like endothelial cell loss, cystoid macular edema, and postoperative inflammation.

Patients with hard cataracts may also benefit from femtosecond laser cataract surgery as the laser used in the procedure can soften cataracts before they are broken apart.

While femtosecond laser cataract surgery may offer patients a more precise version of the procedure it has a number of disadvantages when compared with traditional cataract surgery.

These include:

Traditional cataract surgery provides a more cost-effective treatment option than femtosecond laser cataract surgery. Traditional surgery, with monofocal lenses, is covered by medicare and most insurance companies. This means most patients will not need to pay out of pocket.

Insurance may pay for part of femtosecond laser cataract surgery, but patients will typically pay for some of the surgery out of pocket. The costs for those without insurance is significantly higher—ranging between $3,500 to $7,000 per eye.

In cases where patients don’t need some of the benefits of femtosecond laser cataract surgery, such as correction for astigmatism or premium lenses, they may prefer the simpler traditional cataract surgery.

Traditional cataract surgery has been around for more time and thus has a longer track record of success.

Some clinics may not have the technology used in femtosecond laser cataract surgery. In these cases traditional cataract surgery may be more accessible for patients.

It has been nearly 15 years since the FDA approved femtosecond laser cataract surgery. During this time there have been a number of studies about the efficacy of both procedures.

The studies have found both procedures to be safe and reliable for patients. The choice between traditional cataract surgery and femtosecond laser cataract surgery will ultimately come down to patient preference.

Patients looking for a simple, low-cost, and widely available procedure may be more inclined to choose traditional cataract surgery.

However, patients looking for a more advanced option may opt for femtosecond laser cataract surgery. This is especially true for those looking to correct visual problems like astigmatism and who don’t mind paying a little more out of pocket.

If a patient is having difficulties choosing between the two surgeries, they should talk with their eye doctor for further information.