/ /

  • linkedin
  • Increase Font
  • Sharebar

    Effectively comanaging femtosecond laser-assisted cataract surgery

    Understand the procedure first

    The use of a femtosecond laser during cataract surgery is now an option for your patients, and you need to be comfortable answering patient questions and co-managing this procedure. Your surgeon may refer to the procedure using several acronymns (Table 1). You may be more likely to see a femto-assisted phacoemulsification procedure than femto-assisted LASIK these days, despite the fact that femto procedures started with LASIK. Current femtosecond laser systems use neodymium: glass 1053 nm wavelength light to create a tiny, 3-micrometer spot with an accuracy of 3 microns.1 While slower excimer and YAG lasers create collateral damage of surrounding tissues when fired, the femtosecond laser’s ultrashort pulse (10-15 seconds) does not damage surrounding tissues. The pulse results in a plasma formation and, secondarily, cavitation bubbles which separate tissue in a process called “photodisuruption.”

    Femtosecond laser-assisted cataract surgeryFigure 1Originally, femtosecond lasers used photodisruption in LASIK to create a flap. This was expanded to include channels for corneal segments, astigmatic keratectomy (AK), or limbal incisions for astigmatism correction, and incisions for corneal transplants. This technology has now been applied to cataract surgery. How is the technology used in modern cataract surgery? The femtosecond laser is utilized in several steps prior to phacoemulsification. The capsulorhexis, lens fragmentation, clear corneal incision, paracentesis, and arcuate incisions are all created using the femtosecond laser. Once the laser treatment is complete, phacoemulsification is performed.

    Currently, 5 systems are available for femto-assisted surgery.2 These include the Catalys (Optimedica), LenSx (Alcon Laboratories, Inc), Victus (Bausch + Lomb), LensAR (Lensar, Inc.), and the Victus (Technolas). FDA-approved procedures are listed for each system in Table 2.

    Femtosecond laser-assisted cataract surgeryFigure 2Most systems create the capsulorhexis, fragment the lens to facilitate removal, and then create corneal incisions. The laser requires a patient interface to properly dock the eye (Figure 1). Once the eye is properly docked, imaging allows treatment parameters to be viewed, and confirmed by the surgeon (Figure 2).



    The femtosecond laser is able to precisely create the capsulorhexis while reducing the risks of tearing the capsule and preventing decentration (Figure 3).  Typically a diameter of 5.0 mm is used, but this is easily modified by the surgeon based on pupil diameter and chosen intraocular lens (IOL). Several studies have found laser capsulotomies to be more precise in reproducibility and size than manual capsulotomy.2 Improved refractive outcomes with less lens tilt and decentration have also been reported.3 Psuedoexfoliation, subluxation, and hypermature cataracts are associated with complications during capsulorhexis in cataract surgery, and this technology may be particularly beneficial in these cases.

    Femtosecond laser-assisted cataract surgeryFigure 3AThe capsulotomy is particularly important for effective lens position and refractive outcomes. When calculating IOL power, historical formulas represent the effective lens position with a single number. We know that the IOL is not a thin lens. We cannot accurately predict where the IOL will sit based upon the axial length and keratometry, and lenses of different powers will not be located in the same plane due to the difference in shape. This introduces error and affects the refractive outcome. The size of the capsulotomy has a direct effect on the anterior chamber depth.4 Precise control of the capsulorhexis is thought to increase the likelihood of the desired refractive outcome.


    Femtosecond laser-assisted cataract surgeryFigure 3B

    Tracy Schroeder Swartz, OD, MS, FAAO
    Tracy Schroeder Swartz currently practices at Madison Eye Care Center in Madison, Alabama. She serves as Education Chair for the ...


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available

    Optometry Times A/V