Laser cataract surgery is an upgraded surgery process that is performed through Femtosecond laser technology which results in accurate precisions to the procedure of traditional cataract surgery which was previously performed using hand-handled tools. It is also known as Refractive Laser-Assisted Cataract Surgery (ReLACS) and is referred to as advanced cataract surgery.
In laser cataract surgery, the procedure is performed in three steps.
- The corneal incision
- The anterior capsulotomy
- Cataract and lens formation
The accuracy, reproducibility, and additional precision in the steps of a cataract laser surgery can eventually improve the visual outcomes and lessens the risk factors that often remain at surgeries with hand-handling surgical tools.
Steps of Laser Cataract surgery
The corneal incision
The laser cataract surgery procedure starts with making an incision inside the cornea. Your surgeon will take help from optical coherence tomography to choose the depth as well as the location of the incision while performing laser cataract surgery. Optical coherence tomography (OCT) can offer HD resolution cross-dimensional images to make the cataract procedure as easy and quick as possible.
Before laser cataract surgery was introduced, surgeons used hand handles, tools, and instruments engraved with diamond or metal blades to create an incision just near the sclera where it meets the cornea.
The incision is necessary for both traditional and laser surgeries as it creates access for surgeons to the inner eye area where they can easily extract the cataract. The cataract is essential to remove with the surgery as it creates the blockage by forming clouds in front of the eye that locks the vision. This is because the cataract is just located right behind the pupil and it is easy for it to gain access to the natural lens and block vision.
Once the incision is made, the natural cloudy lens is replaced with an intraocular lens (IOL). The cornea incision is performed in a very special manner that once the surgery is completed, it will self-heal itself without the need for a single stitch.
The precise corneal incision is possible because of OCT (optical coherence tomography) scans and high-definition images. The images enable an eye surgeon to plan accurate incision procedures.
The aim is to create an in-depth incision at a specific location in all the relative planes with the help of femtosecond laser and 3D OCT images. With this, the procedure is performed exactly the way it is planned without needing prior surgical experience from a surgeon.
The procedure is not only critical but is essential to perform accurately as it soars the possibility of self-healing after the system that not only reduces the infection dangers but also eliminates the need for stitches.
The lens of the eye is naturally covered by a very clear but thin transparent capsule which protects the lens from getting damaged by dirt or chemicals on contact. In laser cataract surgery, this thin layered capsule is removed from the front of the lens so the surgeon can directly contact the cataract (lens). This step is called an anterior capsulotomy.
However, for a complete recovery, it is essential that the capsule doesn’t get damaged during the surgery. This is because it will keep the artificial lens in its place as it was securing the original lens before the incision. It also heals itself after the surgery keeping the artificial lens safe for the rest of a patient’s life.
During traditional cataract surgery, a surgeon puts a needle in the capsule to create an opening and moves the forceps in a circular motion in order to tear the capsule.
When cataract surgery is performed using advanced laser technology, it accompanies anterior capsulotomy and a femtosecond laser. This type of laser procedure is used in vision correction surgery like LASIK. Studies have proved that surgeries like capsulotomies that are performed by laser technologies are greater in accuracy and productivity.
In addition, studies have also shown that laser capsulotomies help better in centering the lens, and positioning IOL is one of the main factors that determine the visual outcomes.
Cataract and lens fragmentation
Once the capsulotomy is performed, the surgeon will move to the cataract to remove it.
When traditional cataract surgery is performed, an ultrasonic device is used to break the cataract and inserted it into the incision. During the procedure, which is called the phacoemulsification procedure – the ultrasound device produces heat energy to penetrate the incision. With this method, there’s a high chance that the heat will damage the incision and negatively affect the vision after surgery that happens by inducing astigmatism.
When the incision burns, it not only affects the vision but elevates the chance of leakage which eventually needs sutures to keep it ceasing.
On the flip side, the laser procedure softens the cataract so it can be easily removed. The laser breaks cataracts into tiny pieces which need even smaller energy to eradicate cataract pieces. Not only this, but it also decreases the chances of distorting and burning of incision thus the visual outcome remains protected.
Vision issues do not only occur by burning of incision but if the surrounding capsule is damaged during the procedure, the negative effects of a broken capsule will affect visuals as well. Besides, it can only be addressed after the surgery.
The capsule as mentioned is a clear thin film just like a cellophane wrap. It is essential that the remaining part of the capsule remains undamaged to hold the artificial lens or IOL in place after surgery for an undistorted view.
Furthermore, the lesser energy consumption in laser cataract surgery makes it safer for the delicate inner eye by reducing complications like a detached retina.
What to expect after the surgery?
Once the surgery is performed, the patient will be given the necessary painkillers. Surgeons and nurses will ensure that the patient is able to walk and eat with ease. Depending on the severity of the surgical pain, swelling, leakage, or bleeding, a patient will be admitted to the hospital for one or two days. Otherwise, if there’s no indication of pain or any other complications, they will be discharged the same day.
It is also essential to provide postsurgical instructions to the patient for the surgical eye such as signs of complications, follow-up appointments, and steps to care for the surgical eye.
After the procedure, the recovery time may take weeks and sometimes months – depending on the type of surgery. But if the surgery has gone well, you will be able to see clearly within a few days. you will likely be allowed to drive after the first week of your surgery. But you should wait until your provider gives you the go-ahead before you get behind the wheels.
If you have got an adjustable IOL placement, you probably have to see your doctor within two weeks, otherwise, a visit in a week is scheduled. During these visits, your doctor will examine your surgery to test your vision and apply for your prescribed medicine directly to your implanted cataract with ultrasound light.
You need to see your doctor after a few months of your surgery. Depending on your surgery, you must be fully recovered within three months.
The healing process
You need to keep a check with the doctor after your cataract surgery until the complete healing takes place. Make sure to take ultra-care while you perform your day-to-day tasks. Give extra care to your eyes during face wash and taking a bath. Getting water and chemicals into your eyes can seriously harm eyes. Wear glasses when going outside. Protect your eyes from direct sunlight and indoor bright lights.
You may see bright circular movements around your vision on the first days of your healing process. Your eyes are likely to feel gritty or dry, do mention this to your consultant, he may suggest you have artificial tear drops.
How to deal with your recovery
You may go through different stages once your recovery process starts. It will start distorted vision at the first time which proceeds to gradual vision stabilization. This happens because the natural capsule shrinks and mends the incision itself to keep the artificial lens in place.
The cataract surgery may cause a vision change that would make it tough for you to drive and walk properly in the future. The problem may not be as big that cannot be solved on time. Feel free to ask your consultant about your vision changes and if something unexpected is happening from the ones that you were told to expect.
Cataract surgery is the one that you should be looking for your cataract instead of going under traditional ways. There are a number of clinical advantages of cataract surgery which is performed through technological advanced resources. However, it cannot be safe for everyone or everyone may not be eligible to have it. Make sure to know your insurance coverage and talk to your provider for the best clinical treatment.