Laser vs Traditional Cataract Surgery
Cataract surgery is a common procedure that has helped millions of people improve their vision. However, as with any medical procedure, it’s important to understand your options.
In this article, we will compare two types of surgery: traditional cataract surgery and laser assisted cataract surgery.
This comparison will help you make an informed decision about your eye health. For a more detailed guide on cataract surgery, you can refer to our comprehensive cataract surgery guide.
Cataract Surgery Basics
Cataracts cloud the natural lens of the eye, leading to blurry vision and difficulty with daily activities. Cataract surgery is performed to replace the cloudy natural lens with a clear, artificial one, improving vision significantly. A cataract surgeon is an ophthalmologist and medical doctor that performs hundreds to thousands of cataract surgeries every year.
Traditional Cataract Surgery
In traditional cataract surgery, also known as manual cataract surgery or conventional phacoemulsification, the surgeon makes a small incision in the window of the eye, called the cornea. This is a manual incision made with a blade. You don’t feel this at all because the cornea is made completely numb with just eye drops.
A circular opening is made in the capsule surrounding the cataract, called a capsulorrhexis. This is also a manual step performed by the surgeon.
A tiny probe is then inserted, which emits ultrasound waves to break up the cloudy lens.
The pieces are then suctioned out, and a clear artificial lens is inserted.
The surgery takes about 5-10 minutes in total and patients will experience some mild discomfort and pressure.
No lasers are used in any part of traditional cataract surgery.
Laser-Assisted Cataract Surgery
Laser cataract surgery, on the other hand, uses a femtosecond laser to create the cornea incisions, make the circular capsular opening, and break up the cataract.
The laser provides a high level of precision with the size and depth of the incision, and with the size and roundness of the capsular opening.
Dense or advanced cataracts are easier for the surgeon to remove because the laser has already broken up the cataract into smaller pieces.
The rest of the procedure is similar to traditional cataract surgery, with the cloudy lens removed manually and replaced with an intraocular lens implant.
That is why it is referred to as laser-ASSISTED, since the laser is only involved in some parts of the procedure.
Comparing Laser and Traditional Cataract Surgery
When comparing laser and traditional cataract surgery, several factors come into play. Here’s a table summarizing the key differences:
|Traditional Cataract Surgery
|Laser-Assisted Cataract Surgery
|Risk of Complications
|Additional Cost for Laser
Both types of surgery are effective at treating cataracts.
However, laser-assisted surgery can offer greater precision, which may lead to a slightly quicker recovery and a lower risk of complications. However, these benefits come at a higher cost, which is an important factor to consider.
In the following sections, we will delve deeper into these aspects, providing you with the information you need to make an informed decision about your cataract surgery.
Is Laser Cataract Surgery Worth the Cost?
For my patients, the short answer is no.
The cost of laser cataract surgery is higher than traditional cataract surgery. The additional cost ranges between $1,500-$3,000 per eye. This is in addition to any premium lens implant patients might choose.
The additional laser cost stems from the cost of femtosecond-laser equipment, additional training required, and the extra time it adds to the cataract surgery overall.
Patients with standard age-related cataracts won’t notice a difference in their outcomes when the surgery is performed by an experienced surgeon. This is true for the vast majority of patients and studies support this conclusion.
A study looking at femtosecond laser-assisted cataract surgery (FLACS) compared with phacoemulsification found that FLACS was not cost effective.
Some patients with very dense or advanced cataracts might experience small benefits in recovery time due to less corneal swelling in the early stages of recovery. But the end results is typically the same when comparing laser cataract surgery and traditional cataract surgery.
For patients interested in the best vision outcomes and indepedance from glasses, then their money is better spent on premium lens implants like a toric, extended depth, multi-focal, or light adjustable implants.
Is Laser Cataract Surgery Covered by Medicare?
Medicare typically only covers traditional cataract surgery. However, the additional cost of laser-assisted cataract surgery may not be fully covered. Medicare may cover the portion of the surgery that corresponds to traditional cataract surgery, but you may be responsible for the additional cost associated with the laser procedure.
It’s important to check with your insurance provider to understand what is covered before making a decision.
Is Laser Cataract Surgery Painful?
Cataract surgery, whether traditional or laser-assisted, is usually performed under local anesthesia. This means that you should not feel pain during the procedure.
Patients will receive numbing eye drops just as they do in the clinic. They will also receive a mild sedation to help relieve any anxiety during the procedure. This can be administered by mouth or by an intravenous line.
Some patients report feeling slight pressure or discomfort, but not pain.
After the surgery, any discomfort is typically mild and can be managed with over-the-counter pain relievers.
Is Laser Cataract Surgery Safer?
The short answer is no.
Laser-assisted cataract surgery offers a high level of precision, which can reduce the risk of certain complications. However, both traditional and laser cataract surgery are considered safe procedures with low complication rates.
The experience and skill of the surgeon has the most impact here.
The most common complication in cataract surgery is posterior capsular rupture with an approximate rate of 1.95%. This will vary widely with the cataract surgeon experience and skill.
For the last several years and after thousands of cataract surgeries, my rate for posterior capsular rupture is <0.2%. That’s almost ten times less than the national average.
What Are the Disadvantages of Laser Cataract Surgery?
While laser cataract surgery offers several advantages, there are also potential disadvantages to consider.
The higher cost is a significant factor, especially for those without insurance coverage for the procedure.
Additionally, while the laser offers greater precision, this does not necessarily translate to better visual outcomes compared to traditional cataract surgery.
Laser-assisted cataract surgery can lead to more complications with inexperienced surgeons as it does introduce more variables and steps. There is a learning curve that the surgeon must overcome.
The additional cost of the laser might prohibit patients from budgeting for an implant that will have an impact on vision and quality of life. These include astigmatism or presbyopia correcting artificial lens implants.
Success Rate of Laser Cataract Surgery
Laser cataract surgery has a high success rate, with most patients achieving improved vision following the procedure.
This is also true of traditional cataract surgery.
However, individual results can vary, and success can depend on factors such as the surgeon’s skill, the specific technology used, and the patient’s overall health and eye condition.
My Experience with Laser Cataract Surgery
As an experienced ophthalmologist, I’ve performed thousands of cataract surgeries, both traditional and laser-assisted.
Yes, the laser is very precise and allows for accurate incisions, capsular openings, and effective lens fragmentation.
But, I found that patients that undergo laser cataract surgery did not experience smoother or quicker recoveries compared to manual cataract surgery.
A well-performed traditional cataract surgery can yield excellent results, just as a poorly performed laser-assisted surgery can lead to complications.
In my practice, I always discuss the options with my patients, taking into consideration their specific needs, health conditions, and financial situation.
I believe in providing personalized care and helping my patients make informed decisions about their eye health.
FAQs About Laser Cataract Surgery
Can I drive after laser cataract surgery?
It’s generally recommended that patients arrange for someone else to drive them home after cataract surgery, as your vision may be blurry immediately after the procedure.
The anesthesia you receive for cataract surgery will also have an impact on your ability to drive home the day of surgery.
Your doctor will advise you on when it’s safe to resume driving, typically after your follow-up appointment the next day.
How long does it take to recover from laser cataract surgery?
Most patients notice an improvement in their vision within a few days after laser cataract surgery. However, full recovery can take several weeks as your eye adjusts to the new lens.
Your doctor will provide specific instructions for post-operative care to ensure a smooth recovery.
Are there any restrictions after laser cataract surgery?
After cataract surgery, you’ll need to avoid strenuous activities and rubbing or squeezing your eye for several days. You should also avoid swimming, or exposing your eyes to dirty environments for two weeks. You can wear sunglasses outside if you are experiencing some light sensitivity but this is not mandatory.
Can cataracts come back after laser cataract surgery?
Once a cataract has been removed, it cannot come back. However, some patients may experience a condition known as posterior capsule opacification (PCO), which can cause cloudy vision. This is not a new cataract, but a thickening of the lens capsule that held your lens. PCO can be easily treated with a quick laser procedure called a YAG laser capsulotomy.
For a more detailed guide on the specific steps involved during cataract surgery, you can refer to our comprehensive guide on steps of cataract surgery.
Remember, every patient’s situation is unique, and the best choice for you will depend on various factors, including your overall health, the severity of your cataracts, and your post-surgery vision goals. Always consult with your healthcare provider for personalized advice.