Evidence Based

Laser Cataract Surgery

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 the lens to turn hazy and yellow. This process 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

If left untreated, cataracts tend to progress over time, some faster than others. In many cases, mild cataracts do not require treatment. However, if your vision becomes impaired, cataract surgery may be necessary. This procedure removes your cataract and restores your vision with an artificial lens (intraocular lens implant).

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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 most common form of cataract surgery is phacoemulsification. Phacoemulsification involves using ultrasonic energy to break the cataract up into smaller pieces, making it easier for the surgeon to use a suction device to remove the cataract from your eye.

Laser-assisted cataract surgery, or laser cataract surgery, modifies some steps of a standard phacoemulsification procedure. Using a laser allows the surgeon to be more precise. The operation is also less traumatic to the eye since the use of ultrasonic energy is not required.

Systems Used in Laser Cataract Surgery

Laser cataract surgery involves using a femtosecond laser, which is the same type of laser used for LASIK. The laser system contains sophisticated software that allows the surgeon to create a detailed map of your eye. This system includes an ultrasound imaging device that measures your lens and other structures in your eye. 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.

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 program allows the surgeon to specify the exact depth, size, and location of this incision. This incision is the opening through which the surgeon can insert instruments during cataract surgery.

  1. 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.

  1. Lens Fragmentation 

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

  1. 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.

  1. 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 presbyopia (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.

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 surgery.

About a week before surgery, the surgeon takes several measurements to determine which lens implant is best for you. You will 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, make sure you start any prescribed eye drops as directed by your surgeon. Do not drink alcohol the night before. Refrain from drinking or eating anything after midnight, until after your surgery. Get lots of sleep the night before your surgery.

After Surgery & Potential Side Effects

Cataract surgery is a safe procedure that only takes about 15 minutes per eye. After the operation is over, you will briefly rest in the recovery area. Once the surgeon clears you to go home, it is 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 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 heals, usually about a month.

Do’s and don’ts after cataract surgery:

  • Wear eye shields while sleeping for the first week. Typically, these are provided after your surgery.
  • Use the medicated eye drops as directed. 
  • Take a few days off work to recover.
  • Do not perform heavy lifting or vigorous exercise for a week.
  • Avoid swimming and hot tubs for a week.
  • Avoid rubbing or pressing on your eye.

You are likely to experience some side effects shortly after surgery, which include:

  • Cloudy or hazy vision
  • Red or bloodshot eye (related to broken blood vessels)
  • Dryness or irritation
  • Mild soreness
  • Light sensitivity

These side effects are typical and usually go away within a week. However, it is important to distinguish between these side effects and more severe complications. These are some concerning symptoms to watch for:

  • 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 that requires prompt medical attention. Additionally, symptoms of flashing lights or dark spots could indicate a retinal detachment, which must be addressed immediately by your doctor.

Laser Cataract Surgery Cost 

Generally, laser cataract surgery costs more than standard cataract surgery. Laser cataract surgery may cost anywhere between $3,500 to $6,000 per eye without insurance. Cost may vary depending on several factors:

  • 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 the entire (or a significant portion of) cataract surgery. Since many patients who receive cataract surgery are over 65, Medicare covers a majority of cataract surgeries in the United States. Some private medical insurances also cover cataract surgery.

However, there are some caveats. Most insurance plans only cover traditional cataract surgery with a standard IOL. There are out-of-pocket costs if you want 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, cataract surgery is considered medically necessary only when the cataract has progressed to a certain point. Your eye doctor can determine how significantly the cataracts are impacting your vision. If the cataract is not large enough, the insurance provider does not consider the surgery medically necessary and will not cover your procedure. In this case, you must decide whether to wait and see if the cataract gets worse, or choose to pay out-of-pocket for your surgery.

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 on your eye. By incorporating 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 incisions.

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 determine if laser cataract surgery 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 correct astigmatism.

Author: Melody Huang, O.D. | UPDATED July 15, 2020
Resources

Bethke, Walter. “Get to Know Your Femtosecond Options.” Review of Ophthalmology, 6 July 2015, www.reviewofophthalmology.com/article/get-to-know-your--femtosecond-options.

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.

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.

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

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.

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