How laser cataract surgery stacks up against conventional phaco
Today’s laser cataract surgery is outperforming the early days of phacoemulsification and may outperform current phacoemulsification technology in the next few years, explained Yassine Daoud, MD, in a dialogue about the technology.
Take-home message: Today’s laser cataract surgery is outperforming the early days of phacoemulsification and may outperform current phacoemulsification technology in the next few years, explained Yassine Daoud, MD, in a dialogue about the technology.
By Stephanie Skernivitz; Reviewed by Yassine Daoud, MD
Baltimore-Any present-day discussion of femtosecond laser-assisted cataract surgery over conventional phacoemulsification may prompt several relevant questions.
“Is it safer? Is it better? Is it cost-effective?” These three questions are top of mind for Yassine Daoud, MD, assistant professor of ophthalmology, Department of Cornea, Cataract and Refractive Surgery, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore.
Dr. Daoud provided a brief review of the literature to question whether the procedure really is safer.
“The safety of cataract surgery is pretty impressive as far as medicine goes, but it isn’t perfect,” he said.
He cited a number of examples to highlight the procedure’s safety. When addressing the safety of femtosecond laser-assisted cataract surgery compared with conventional phacoemulsification, capsule issues come into play.
Dr. Daoud discussed multiple epidemiological studies that pertain to the rate of various complications, such as anterior capsular tear, which, in regular phacoemulsification, is 2.8%. In femtosecond laser, this can be as high as 4%. With lens dislocation, it is 2% in the femtosecond group, higher than what is normally seen.
“It’s a learning curve,” he said. “Once you master the learning curve, the complication rate becomes lower than conventional phaco.”
For example, one study by Roberts et al. (published in 2013 in Ophthalmology) found that the surgical outcomes and safety of femtosecond laser-assisted cataract surgery improved significantly with greater surgeon experience.
From a historical perspective, in 1997, there was posterior capsular tear in 13.3% of eyes; iris trauma in 4%; and vitreous/dropped lens in 1% in phacoemulsification cases. The total percentage of eyes with complications was 21.7%. Surgery involved 2.6 minutes of ultrasound, and total surgical time was about 18 minutes in experienced hands, according to Dr. Daoud.
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