Speaker: Lasers essential in future of refractive cataract surgery

Issue: February 25, 2014

Laser-assisted refractive cataract surgery, although costly, provides better safety, visual outcomes and reproducibility and will be the driving innovative factor in the future, according to a speaker at Hawaiian Eye 2014.

“The principal source of error that we face now is the effect of lens position,” James P. McCulley, MD, FACS, FRCOphth, said. “A half millimeter off in lens position will give us a diopter off in our IOL.”

The literature supports that the main cause for this variability is the structure of the capsulorhexis, he said.

James P. McCulley

“Now, one of the advantages of laser-assisted cataract surgery is that we get a precise capsulotomy,” McCulley said. “We [can make] intraoperative cuts that let us have a Velcro wound that we can open variably — some at the time of surgery, some after — [which gives us] better intraoperative astigmatism control. We also get watertight wounds without stromal vibration.”

All of these factors allow for a safer, more precise, reproducible outcome with better uncorrected visual acuity, McCulley said.

Disadvantages for laser-assisted refractive cataract surgery include changes in operating room flow, which can slow surgeons down, and cost.

“Those are the two main obstacles to these things being even more broadly accepted,” he said.

McCulley drew attention to some older data that suggest lasers cause more anterior and posterior capsular complications, but he pointed out that as the lasers are evolving, fewer of these complications are being seen.

“There are just some things we can do with the laser that we physically cannot do manually,” he said. “We have a new category that’s emerging in private-pay ophthalmic surgery, similar to what we’ve had with keratorefractive surgery. … The femtosecond laser technology will drive innovation for a true laser refractive cataract surgery.” —by Daniel Morgan

Disclosure: McCulley is a consultant for Alcon and Bausch + Lomb.