Cataract Surgery

A cataract is the clouding of the normally clear lens of your eye. For people who have cataracts, seeing through cloudy lenses is a bit like looking through a frosty or fogged-up window.

Clouded vision caused by cataracts can make it more difficult to read, drive a car (especially at night) or see the expression on a friend’s face.

Most cataracts develop slowly and don't disturb your eyesight early on. But with time, cataracts will eventually interfere with your vision.

At first, stronger lighting and eyeglasses can help you deal with cataracts. But if impaired vision interferes with your usual activities, you might need cataract surgery. Fortunately, cataract surgery is generally a safe and effective procedure.

To determine whether you have a cataract, your doctor will review your medical history and symptoms, and perform an eye examination. Your doctor may conduct several tests, including:

Asking you to read an eye chart (visual acuity test). A visual acuity test uses an eye chart to measure how well you can read a series of letters. Your eyes are tested one at a time, while the other eye is covered.

Using a chart or a viewing device with progressively smaller letters, your eye doctor determines if you have 20/20 vision or if your vision shows signs of impairment.

Using a light and magnification to examine your eye (slit-lamp examination). A slit lamp allows your eye doctor to see the structures at the front of your eye under magnification.

The microscope is called a slit lamp because it uses an intense line of light, a slit, to illuminate your cornea, iris, lens, and the space between your iris and cornea. The slit allows your doctor to view these structures in small sections, which makes it easier to detect any tiny abnormalities.

Dilating your eyes (retinal examination). To prepare for a retinal examination, your eye doctor puts dilating drops in your eyes to open your pupils wide. This makes it easier to examine the back of your eyes (retina).

Using a slit lamp or a special device called an ophthalmoscope, your eye doctor can examine your lens for signs of a cataract.

Cataract Surgery with Femtosecond Technology

Cataract surgery is one of the most frequently performed surgeries in the world today, enabling millions of people to regain eyesight lost because of cataracts. Modern cataract surgery is safe, effective and highly predictable. And surgical tools and techniques are constantly evolving to make the procedure even better.

The next major advance in cataract surgery may be the use of femtosecond lasers — like those used in all-laser LASIK — to perform some of the steps in the cataract procedure.

The Laser Cataract Surgery Procedure

Using a laser for certain steps in cataract surgery has the potential to increase accuracy of the surgical procedure, decrease surgical time, decrease cataract surgery recovery time, and improve visual outcomes.

Basically, here are the four steps of modern cataract surgery and how these steps may be modified in laser cataract surgery:

1- Creating corneal incisions. The first step of cataract surgery is to create an incision, usually in the periphery of the cornea, to enable the cataract surgeon to gain access to the cloudy lens inside the eye. Typically, these incisions are made with a hand-held surgical blade. In laser cataract surgery, they are created with a laser.

2- Performing an anterior capsulotomy. The lens inside the eye is contained within a clear thin sack called the lens capsule. To break up and remove a lens clouded by a cataract, the surgeon must create an opening in the front part of the capsule (anterior capsulotomy). Typically, an anterior capsulotomy is performed with a hand-held cutting tool. In laser cataract surgery, this step is performed with a laser.

3- Lens fragmentation. Prior to removal of a cataract, the cataract surgeon breaks the cloudy lens into smaller pieces, so it can be removed through the very small corneal incision. Typically, this is done with an ultrasonic probe. In laser cataract surgery, this step has not changed, but may change in the future.

4- IOL implantation. After the cataract has been broken up and removed, the eye’s natural lens is replaced with an intraocular lens (IOL), such as a multifocal IOL or an accommodating IOL to correct presbyopia. This step is not changed by laser cataract surgery.

And, if the patient has astigmatism, then an additional step may be incorporated into the cataract surgery procedure.

Creating limbal relaxing incisions (LRI). This step involves making a precise, partial-thickness radial incision in the peripheral cornea. Typically, a LRI is created with a hand-held, bladed tool (much like how RK was performed). In laser cataract surgery, this step may soon be performed with a laser.

Benefits of Laser Cataract Surgery

Surgeons practicing laser cataract surgery report that the new procedure improves the reliability, reproducibility, and the safety of cataract surgery. Refractive and visual outcomes also may be improved with true refractive cataract surgery that extensively reduces or eliminates the need for eyeglasses after surgery.

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