Recently, a new laser device has become available to assist in the performance of cataract surgery.  A cataract is a clouding or opacification of the lens of the eye.  It generally causes progressive loss of vision possibly associated with night vision disturbances such as glares or halos.   Its typical onset is middle age and onwards.  Everyone will eventually develop significant cataracts although there is considerable variability regarding the age of onset for each individual.

Cataract surgery traditionally has involved making a opening through the wall of the eye, and inserting instruments to remove the cataract.  Earlier forms of the surgery such as intracapsular cataract extraction or extracapsular cataract extraction (ICCE or ECCE), required the creation of very large incision through the wall of the eye, and removal of large portions of the cataract in a single piece.  The more modern approaches employ a very small incision through the wall of the eye which minimizes the trauma and improves healing time.  An ultrasonic device called a phacoemulsifier is inserted through the wall of the eye and into the substance of the cataract.  This vibrates at very high frequencies.  It softens or emulsifies the hard nucleus of the cataract into a soft material which can easily be removed from the eye using suction.  Once the entire contents of the cataract have been removed, an artificial lens implant is inserted into the eye which then takes place of the focusing power that the original lens possessed.   This technique of cataract surgery is referred to as phacoemulsification.  It has become the mainstay of cataract surgery in the modern ear.

While for some time, many patients have assumed that the small incision phacoemulsification procedure was actually “laser cataract surgery”, it was not.  It was only of the advent of the femtosecond laser that true laser-assisted cataract surgery became widely available.  The femtosecond laser is able to automate certain key elements of the cataract surgical process. It is currently able to perform the following steps:

1. It can create a precise opening through the anterior capsule which is the outer wall of the cataract. The capsule is a cellophane type membrane which needs to be removed much like opening a can in order to access the hard contents of the cataract.  In the traditional phacoemulsification surgery, this opening of the anterior capsule is performed manually using needles and forceps. However, the femtosecond laser can create a circular opening located at the precise position and precise size required by the surgeon.
2. Nuclear Softening: The femtosecond laser is able to pre-soften the hard nucleus of the cataract, which will makes its subsequent removal easier, requiring less time and energy employed by the phacoemulsification unit. This may lead to less inflammation, swelling, and faster recovery time.
3. The femtosecond laser is able to create incisions in the cornea which can be created with great precision in terms of lengthen orientation. This precision may be used to reduce preexistent astigmatism in the eye. As such, it may lead to a better unaided visual outcome with less dependence on the use of spectacles to achieve the best visual acuity.
4. The femtosecond laser may also be used to create the initial opening through the wall of the eye, which is required to remove the opacified contents of the cataract as well as to insert the lens implant.

While the femtosecond laser does not perform the entirety of the cataract surgery, utilizing the steps as noted above may improve the precision of the process, and possibly lead to faster recovery time.  This technology is now available to patients who are undergoing cataract surgery, who meet certain requirements regarding the ability of the pupil to adequately to dilate, and who are not suffering from certain corneal disorders which could produce scarring or irregularity.  Each patient undergoing cataract surgery should have a detailed discussion regarding the potential use of this technology in their specific situation.