It’s quite common for those who have had cataract surgery to notice tearing, foreign body sensationmild soreness, “scratchy eye”, or a “tired eye” for a period of time after surgery1,2,3. Although not entirely understood there are a few likely suspects including, (1) the preservative contained within the many drops used before and after surgery, (2) drying out of the ocular surface during cataract surgery, and (3) decreased blink rate secondary to a “numb” cornea.

Femto laser-assisted cataract surgery has been touted by many as a “gentler” method of cataract surgery. In fact, there is little objective evidence to suggest that laser-assisted cataract surgery is any gentler than ultrasound-only cataract surgery. However, there is now reason to believe that dry eye syndrome could be worse after laser-assisted cataract surgery.

In December 2015 a study comparing dry eye after laser-assisted cataract surgery to ultrasound-only cataract surgery was published in the Journal of Cataract and Refractive Surgery4. Although both types of cataract surgery resulted in temporary worsening of dry eye symptoms, those who had undergone laser-assisted cataract surgery experienced more severe symptoms. This difference between surgical groups was both modest and short-lived (one week). By one month after surgery both groups had similar dry eye symptoms. However, evidence of dry eye syndrome continued to be more pronounced in the laser-assisted cataract surgery group even one month after surgery.

It appears, then, that dry eye may be worse after laser-assisted cataract surgery compared to ultrasound-only cataract surgery. Although this difference may be modest, at least in this regard laser-assisted cataract surgery is not, in fact, “gentler” than ultrasound-only cataract surgery. Thus, the search continues…just what is meant by surgeons who advertise laser-assisted cataract surgery as “gentler”?

As with the old TV series, “In Search of…”, we may never discover the answer to this mystery. Could it be that the vagueness of the word “gentler” was intentional?

In Search of Gentler laser-assisted cataract surgery


2 Cho YK, Kim MS. Dry eye after cataract surgery and associated intraoperative risk factors. Korean J Ophthalmol 2009; 23:65–73.

3 Han KE, Yoon SC, Ahn JM, Nam SM, Stulting RD, Kim EK, Seo KY. Evaluation of dry eye and meibomian gland dysfunction after cataract surgery. Am J Ophthalmol 2014; 157:1144–1150

4 Evaluation of dry eye after femtosecond laser-assisted cataract surgery. Yu Y, Hua H, Wu M, et al. J Cataract Refract Surg. 2015 Dec;41(12):2614-23.

About the Author:

About Eyes David RichardsonDr. David Richardson has performed thousands of cataract surgeries without the need for laser assistance. Although he finds Femto technology to be interesting he is far from convinced that there is any real benefit to his patients. As such, he has chosen not to recommend this technology to his patients who need cataract surgery.

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