Updated on 

December 15, 2021

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Laser Cataract Surgery

Cataract surgery is a procedure to remove cataracts from your eye and restore your vision.

Cataracts are a common, age-related eye condition in which the natural lens of the eye becomes cloudy. At birth, this lens is transparent and allows you to see clearly.

Around age 60, proteins in the lens start to break down, causing it to turn hazy and yellow. This may occur faster in people who frequently spend time in the sun or who smoke cigarettes.

These are common symptoms of cataracts: 

  • Blurry vision
  • Poor night vision
  • Glare and halos 
  • Light sensitivity
  • Difficulty reading
  • Dark or blurry spots in the vision
  • Shifts in color perception (whites tend to look more yellow)
  • Ghosting or double vision with one eye open
  • Significant shifts in the eyeglass prescription

Left untreated, cataracts can progress over time, some faster than others. Mild cataracts may not require treatment. However, if your vision becomes impaired, surgery may be needed.

Laser cataract surgery involves removing your natural lens (and cataract within). It's then replaced with an intraocular lens implant (artificial lens).

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2 Types of Cataract Eye Surgery

There are two main types of cataract surgery. Your eye doctor can help determine which one is best for you.

The first and most common is called phacoemulsification. The procedure utilizes ultrasonic energy to break the cataract up into smaller pieces.

This makes it easier for the surgeon to use a suction device to remove the cataract from your eye.

The other type is laser-assisted cataract surgery, or laser cataract surgery. This involves modifying some of the steps of phacoemulsification, mainly through use of a laser.

Using a laser allows the surgeon to be more precise. It's also less traumatic to the eye since the use of ultrasonic energy isn't required.

Systems Used in Laser Cataract Surgery

Laser cataract surgery involves using a femtosecond laser (the same kind used for LASIK). The laser system contains sophisticated software that allows the surgeon to create a detailed map of your eye.

It also contains an ultrasound imaging device that measures your lens and other eye structures. The surgeon uses this information to program the laser, allowing for highly precise surgery.

Some of the laser systems available include LenSx, LENSAR, Catalys, and Victus.

Preparing for Surgery

First, the eye doctor performs a complete exam to make sure your eyes are healthy enough to undergo cataract surgery.

If you have any health conditions or are taking medication, inform your eye doctor, as certain conditions and medications may increase your risk for complications during eye surgery.

About a week before surgery, the surgeon takes several measurements to determine which lens implant is best for you. You'll want to make sure you schedule the necessary follow-up appointments and arrange for a ride home on the day of your surgery. 

The day before surgery, be sure to:

  • Start any prescribed eye drops as directed by your surgeon
  • Not drink alcohol the night before
  • Refrain from drinking or eating anything after midnight
  • Get lots of sleep

Laser Cataract Surgery Steps

There are a few general steps involved in laser cataract surgery: 

1. Corneal Incision

Instead of using a surgical blade, the surgeon uses the laser to make an incision in your cornea. The laser’s software allows the surgeon to specify the exact depth, size, and location of the incision.

This incision is the opening through which the surgeon can insert instruments during cataract surgery.

2. Anterior Capsulotomy

The capsule is a thin membrane surrounding your natural lens. You can think of the capsule as a bag that helps the lens maintain its shape. To access the cataract, the surgeon must make an opening in the front (anterior) of the capsule.

In traditional cataract surgery, a surgical instrument is used to create a small tear in the capsule. This procedure is called a capsulorhexis. Rather than a surgical instrument, the laser can create the opening in the anterior capsule.

3. Lens Fragmentation 

During this step, the surgeon uses the laser to soften the cataract and break it up into pieces for easier removal. The surgeon can specify how they want the laser to segment the cataract.

4. Lens Removal

Similar to traditional cataract surgery, the surgeon inserts a small probe that emits ultrasound energy and can suction the fragments out of your eye.

The main difference is that because the laser has already softened the cataract, the surgeon can use less ultrasonic energy. This is why laser cataract surgery is more gentle than traditional surgery.

5. Intraocular Lens (IOL) Implantation

Once the natural lens has been removed, the surgeon inserts the artificial lens implant into its place.

Many different types of IOLs are available, depending on your vision. For example, if you have age-related farsightedness, you may choose a multifocal IOL to correct near and far vision. If you have astigmatism, there are toric IOLs that correct astigmatism.

Your surgeon can help determine which implant can give you better vision.

How Long Does Cataract Surgery Take?

The procedure only takes about 15 minutes per eye. After the procedure is finished, you should plan to rest for 30 minutes to recover from the effects of sedation.

How Long Does it Take to Recover from Cataract Surgery?

Once the surgeon clears you to go home, it's a good idea to rest for a few hours. The surgeon will see you the following day to make sure your eye is healing properly.

Your eye takes at least a month to fully heal, although you can resume most of your normal activities much sooner. Many people experience clearer vision within several hours of surgery.

If you need cataract surgery in your other eye, the surgeon will wait until your first eye fully heals.

Post-Surgery Dos & Don'ts and Potential Side Effects

Some things to do and not do after cataract surgery include:

  • Do eye shields while sleeping for the first week (typically, these are provided after surgery).
  • Don't perform heavy lifting or vigorous exercise for about a week.
  • Do use the medicated eye drops as directed. 
  • Don't rub or press on your eye.
  • Do take a few days off work to recover.
  • Don't swim or use hot tubs for a week.

Shortly after surgery, you're likely to experience the following side effects:

These side effects are typical and usually pass within a week.

However, it's important to distinguish between these side effects and more severe complications.

Concerning symptoms to watch for include:

  • Blurry vision that is worsening instead of improving
  • Worsening eye pain
  • Mucous discharge
  • Increased redness and swelling 
  • Extreme light sensitivity that is worsening

These symptoms could indicate infection or inflammation, requiring prompt medical attention. In addition, symptoms of flashing lights or dark spots could indicate a retinal detachment, which must be addressed by a doctor quickly.

Laser Cataract Surgery Cost 

Laser cataract surgery generally costs more than standard cataract surgery. Pre-insurance, the cost ranges between $3,500 to $6,000 per eye.

Factors influencing the cost include:

  • Experience of surgeon
  • Technology used for the surgery
  • Your location (higher cost-of-living areas tend to be pricier)
  • What type of implant you choose (premium IOLs such as multifocal or toric cost more than a standard IOL)

Insurance Information

Fortunately, health insurance may cover much or all of the cost. Since many cataract surgery patients are over 65, Medicare covers a majority of procedures in the United States. Some private medical insurances also cover it.

However, there are some caveats. Most insurance plans only cover traditional cataract surgery with a standard IOL.

There are also out-of-pocket costs to upgrade to laser cataract surgery or select a premium IOL. This can add up to twice or three times the cost of what you usually pay with insurance coverage.

Additionally, surgery is considered medically necessary only after a certain point of vision loss. Your eye doctor can determine how significantly the cataracts are impacting your vision.

If the cataract isn't large enough, insurance doesn't consider the surgery medically necessary and won't pay. In this case, you'll have to either wait and see if the cataract gets worse or choose to pay out-of-pocket.

FAQs — Laser Cataract Surgery

Here are the answers to some frequently asked questions about laser cataract surgery:

How Is Laser Cataract Surgery Different From Traditional Cataract Surgery?

Although both types of cataract surgery are safe and effective, laser cataract surgery is more gentle. By using a laser, the surgeon can apply less ultrasonic energy to your eye during the procedure.

The laser also gives the surgeon a high level of precision when making cuts.

What Are the Main Benefits of Laser Cataract Surgery?

The benefits of laser cataract surgery include precise incisions, a high rate of accuracy, and consistency.

However, more studies are needed to know if it causes fewer complications and delivers better visual results than traditional cataract surgery.

Who Is a Candidate for Treatment?

Generally, if you qualify for traditional cataract surgery, you can have laser cataract surgery. If you have other eye conditions such as corneal disease, your surgeon may recommend laser cataract surgery as a safer alternative.

If you have astigmatism, the surgeon can combine your cataract surgery with a procedure that also uses the femtosecond laser to make small incisions on your cornea, which corrects astigmatism.

6 Cited Research Articles
  1. Bethke, Walter. “Get to Know Your Femtosecond Options.” Review of Ophthalmology, 6 July 2015, www.reviewofophthalmology.com/article/get-to-know-your--femtosecond-options.
  2. Day, Alexander C, et al. “Laser-Assisted Cataract Surgery versus Standard Ultrasound Phacoemulsification Cataract Surgery.Cochrane Database of Systematic Reviews, July 2016, doi:10.1002/14651858.cd010735.pub2.
  3. Dick, H. Burkhard, and Tim Schultz. “A Review of Laser-Assisted Versus Traditional Phacoemulsification Cataract Surgery.Ophthalmology and Therapy, vol. 6, no. 1, June 2017, pp. 7–18., doi:10.1007/s40123-017-0080-z.
  4. Gavris, M Monica et al. “The Advantages Of Femtosecond Laser-assisted Cataract Surgery.Romanian Journal Of Ophthalmology, vol. 59, no. 1, Jan-Mar 2015, pp. 38–42
  5. Vajpayee, Rasikb, et al. “Techniques of Anterior Capsulotomy in Cataract Surgery.Indian Journal of Ophthalmology, vol. 67, no. 4, Apr. 2019, pp. 450–460., doi:10.4103/ijo.ijo_1728_18.
  6. Cataract Surgery.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 19 Aug. 2021.
Melody Huang is an optometrist and freelance health writer. Through her writing, Dr. Huang enjoys educating patients on how to lead healthier and happier lives. She also has an interest in Eastern medicine practices and learning about integrative medicine. When she’s not working, Dr. Huang loves reviewing new skin care products, trying interesting food recipes, or hanging with her adopted cats.
https://www.visioncenter.org/author/melody/
Author: Dr. Melody Huang, O.D.  | UPDATED December 15, 2021
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