Many of you reading this article may not have realized that cataract surgery has evolved rapidly in the past 3-4 years. This pace of change pales in comparison to how the procedure has evolved in the past 50 years. For perspective, the procedure started off around 2000 years ago by an Indian sage named Sushruta. His tools? Early morning rays of sunlight, a long thin needle, ghee (clarified butter) and Sanskrit verses. Fast forward to 2017 and the procedure can be a wonderful mixture of OCT guided real-time imagery, femtosecond laser driven tissue cutting and advanced phacoemulsification with active fluidics.
Is it fancy? Oh yes.
Does Milan Eye Center have one? Of course.
Is it necessary? Well, no and yes.
Though the recent evolution in the cataract surgery space with femtosecond laser is significant, the procedure evolved considerably after the advent of phacoemulsification in the late 1960s by Dr. Charles Kelman. The improvements in phacoemulsification technology since then have been continuous, innovative and powerful. So much so, that outcomes from modern phacoemulsification (this means cataract surgery by hand without laser) are equivalent to femtosecond laser cataract surgery – as has been proven in several studies. Put another way, femtosecond laser cataract surgery is non-superior to manual cataract surgery in many instances – but not all instances.
Just as people don’t come in the same color, shape or size, neither do cataracts. We have learnt over time that certain cataract types are not optimal for manual cataract surgery. Cataracts that are very dense, cataracts that are associated with a weakened cornea and cataracts that are unstable are some of the instances where manual cataract surgery is not ideal. This is where laser cataract surgery shines – no pun intended! Femtosecond laser cataract surgery enables the surgeon to break up a rock-hard cataract before entering the eye, enables the creation of beautiful and perfect circular openings in unstable and misaligned cataracts and minimizes the creation of by-product energy that can harm surrounding tissue. In short, it is a much needed and precise tool for these complex cases. A secondary function of femtosecond laser is astigmatism correction via astigmatic keratotomies. These are precisely placed incisions in the cornea, the clear, dome shaped tissue covering the eye.
The role of laser cataract surgery may evolve still as more advanced intraocular lenses are introduced that require more precise placement. As laser platforms become smaller and more integrated into the operating room workflow, the use may also increase.
Milan Eye Center has available an ultra-mobile, precise femtosecond laser (its Swiss!) for use in cataract and LASIK patients. The Ziemer Z8 has been a tremendous tool for our surgeons in tackling the most complex as well as routine cases – all our surgeons have their own philosophy regarding its utility. The role of this technology in your surgical care, therefore, has to be based on a discussion regarding its efficacy and utility for your eye. Though it may be the best thing since hummus, perhaps, manual cataract surgery by your highly trained Milan Eye Center eye surgeon will suffice. At your next cataract evaluation appointment, consider discussing the pros/cons and cost/benefit ratio of this fantastic tool with any of our surgeons at Milan Eye Center.