Not a week goes by in which I am told by a patient with 100% conviction that her friend had cataract surgery done with a laser. Although it is remotely possible that this conviction is well-founded, I’m going to explain why it’s far more likely that her friend is mistaken.
In fact, the vast majority of cataract surgeries are done using ultrasound energy (also known as phacoemulsification). That being said, it is possible (though unlikely) that the friend in question had laser cataract surgery. During the late 1990s and into the early 2000s there was a brief interest by a very few surgeons in using a laser to remove the cataract. Even so, this still required making a 3mm incision in the eye (so no, you cannot avoid “going under the knife”).
However, the laser technology was far inferior to the advanced ultrasound technology (which has been steadily improved upon since the 1970s). The only surgeons still using this short-lived laser technology are those who invested in it and feel they have to get some mileage out of their investment. Oh, and it does sound sexy to say that a laser is used to remove the cataract.
Ultimately, if someone has a cataract the best option available in the US is an advanced ultrasound technology called “cold phaco.” This beats the pants off any laser still hanging around. Perhaps in a future post I’ll discuss cold phaco in more detail.
So why, then, are so many people convinced that they had their cataracts removed with a laser? The answer is that a laser is used to treat “after cataracts.” This term is actually a misnomer for posterior capsular opacification (or PCO). A PCO is actually a type of scar that forms behind the IOL months to years after cataract surgery. Think of it as similar to frost on a window.
In order to remove this haze and improve vision a YAG laser is used to tear open the capsular bag behind the intraocular lens (IOL). Prior to the use of this laser surgeons used to poke a needle into the eye and scratch the capsule to tear the scar out of the visual axis. Needless to say, the laser is a big improvement over the needle.
As YAG capsulotomy is the second most commonly performed surgery in the world (cataract surgery is the most commonly performed surgery), it is not surprising that many people mistakenly think that cataracts are removed by lasers.
© 2009 David Richardson, MD
A Word About Laser Cataract Surgery
How good is this “cold phaco” ? I guess it is not particular good, since cataract surgery is the most common surgery.
I have heard of a research project, where they will use laser to almost remove all of the cataract, which should avoid operation for 10 more years. I don’t remember the name, but something about femto-nano-second laser (very short bursts of laser).
Cold phaco is very good. It allows for efficient removal of the cataract with minimal risk of wound burn (one of the disadvantages of earlier phacoemulsification technology). It is true that laser technology continues to be researched, but as ultrasound technology continues to improve there simply is not a convincing reason for most cataract surgeons to learn a new platform (with all the unknown risks of new technology). In general, surgeons are gadget freaks, but we also tend toward the conservative side when choosing for our patients.