Does laser-assisted cataract surgery make a difference?

Cataract is a common eye condition in which the eye’s lens loses its transparency, causing blurred vision. It is treated with surgery, and laser-assisted cataract surgery is now offered alongside conventional methods. But does having laser-assisted cataract surgery really make a difference?

Which part of the surgery does the laser perform?

When people hear “laser cataract surgery”, many assume that the entire operation is performed using a laser. In fact, the femtosecond laser only carries out the preparatory steps:

• It makes the small entry incisions in the cornea.
• It creates a circular window (capsular opening) in the front of the membrane surrounding the lens.
• It breaks the cloudy lens into small pieces.

The cloudy lens is still removed using ultrasound energy (phacoemulsification), and an artificial intraocular lens is inserted through the same small incision. In the conventional method, the surgeon performs these preparatory steps using handheld instruments.

How does it differ from the conventional method?

The main difference the laser offers is computer-controlled planning of the incisions and the capsular opening. The centring and diameter of this opening are important for keeping the intraocular lens in position over the long term. Breaking up the lens with a laser beforehand may reduce the amount of ultrasound energy needed in some eyes.

However, other factors play the main role in determining the visual outcome: the accuracy of biometry measurements, the choice of lens and the eye’s own structure. Conventional surgery performed by an experienced surgeon is also a safe and successful option. Using a laser does not mean that it is superior to the conventional method for every patient.

Who might it be considered for?

The laser step may be preferred in certain situations:

• Very hard cataracts
• A borderline cell count on the inner surface of the cornea
• Eyes receiving lenses such as multifocal, trifocal or EDOF lenses

The laser step may not be possible if the pupil does not dilate sufficiently, the cornea has reduced transparency or the head cannot be kept still during the procedure.

How is the decision made?

An examination and measurements help determine whether a laser would make a difference for your eye. Biometry, corneal topography and a cell count of the inner surface of the cornea guide this decision. You can read about the steps of cataract surgery on the Cataract Surgery page and lens options on the Intraocular Lenses: Multifocal, Trifocal and EDOF page.