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Cost may be barrier to capitalizing on advantages of femtosecond cataract surgery
Improvements in instrumentation allow surgeons to measure various ocular parameters with exquisite precision. With the advent of the femtosecond laser, it is now possible to also perform various steps of the intraocular procedure with equal precision. The infrared laser works by delivering energy in extremely short pulses, and the procedure of femtosecond laser-assisted cataract surgery is now available around the world.
One of the key steps of cataract surgery is the surgical incision. Using the laser to fashion the corneal incision may offer greater predictability and the ability to fashion the dimensions more precisely, which can result in more predictable and reduced surgically induced astigmatism. The wound also has the potential to seal tightly, without the need for stromal hydration at the conclusion of surgery, which may reduce the risk of postoperative endophthalmitis.
The laser is able to perform an accurately sized and centered anterior capsulorrhexis, and this increases the locational stability of the in-the-bag IOL. A symmetric overlap of the rhexis margins around the edge of the lens optic ensures that there is no tilt or decentration of the lens, and this is of extreme importance in ensuring the optimal performance of premium IOLs. A study has also shown that this can result in better quality of vision after the procedure.
The laser can be used to liquefy or fragment the lens material using a variety of approaches, including a “cross,” “cake or pizza” or “cubicle” pattern. The softening and segmentation of the lens allows the use of less cumulative energy when using the phacoemulsification probe to evacuate the lens segments from the eye. This results in direct benefits in terms of endothelial buffeting and postoperative corneal thickness and indirect benefits accruing due to less wound manipulation. The laser can also be used to make precise incisions in the cornea to reduce astigmatism.
While studies are currently underway to see whether the theoretical benefits of performing the above steps of cataract surgery with the laser can be substantiated, cost may be a major barrier to the widespread use of femtosecond laser-assisted cataract surgery. It is hoped that results of the many ongoing studies are positive and substantial cost reductions can be made in future. Only when both happen will widespread use benefiting patients around the world become possible.
References:
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Kránitz K, et al. J Refract Surg. 2011;doi:10.3928/1081597X-20110623-03.
Masket S, et al. J Cataract Refract Surg. 2010;doi:10.1016/j.jcrs.2010.03.027.
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For more information:
Dennis S.C. Lam, MD, FRCOphth, can be reached at State Key Laboratory in Ophthalmology, Sun Yat-Yen University, 54 South Xianlie Road, Guangzhou 510060, People’s Republic of China; +852-3997-3266; email: dennislam.gm@gmail.com.
Disclosure: Rao and Lam have no relevant financial disclosures.