#8: Femtosecond Laser for Cataract Surgery

With an estimated 19 million annual operations, cataract surgery is the most common surgical procedure in the world. According to the World Health Organization, the number of worldwide cataract surgeries is expected to increase to 32 million by 2020, in large part due to the aging of the population.

The cataract surgical process saw several significant advances in the 20^th century – most notably thanks to the introduction of IOL implantation and phacoemulsification – that have then been spurred even further in the current century with the introduction of femtosecond laser into the surgical suite.

The femtosecond laser technique was first introduced in 2001 as a new technique for creating lamellar flaps during LASIK procedures. The first femtosecond laser system for use in cataract surgery was approved by the U.S. Food and Drug Administration in 2010 and received a CE Mark in 2011.

Intraoperative swept-source OCT image acquired with the VICTUS(R) Femtosecond Laser Platform (Bausch + Lomb).

There are currently four femtosecond lasers available in the United States and Europe – the LenSx® (Alcon), LENSAR® (Lensar), Catalys® (AMO), and VICTUS® (Bausch + Lomb). While the specifics of each platform vary, the basic procedure for all of them requires the same four steps: preoperative planning, docking the eye, interoperative anterior segment imaging, and treatment. All current femtosecond laser platforms utilize either optical coherence tomography (OCT) or ray-tracing reconstruction (3-dimensional confocal structural illumination) to help map the treatment plan.

Current femtosecond laser platforms offer a variety of potential applications, including creation of limbal relaxing incisions, corneal wound construction, anterior capsulotomy, and lens fragmentation. Surgeons, especially as they are gaining initial experience with the laser, can typically customize their procedures to include as few or as many of these applications as they’d like.

One of the most significant barriers to widespread adoption of femtosecond laser is cost. The acquisition and service costs for each platform are significant – approximately $400,000 to $550,000 in upfront costs and $40,000 to $50,000 in annual maintenance. Mobile, roll-on/roll-off units are now being offered by some manufacturers to lessen the financial burden.