Laser Cataract Surgery: Everything You Need to Know

Laser cataract surgery is when an eye surgeon removes a clouded lens with a laser, then replaces it with an artificial prescription lens that restores clear vision. This method results in better healing and fewer complications than traditional cataract surgery, which uses a scalpel.

The procedure is safe and effective, though it's not without any risks. However, laser cataract surgery is more costly than the traditional method and not covered by most health insurance plans.

What Is Laser Cataract Surgery?

Laser cataract surgery is an outpatient surgical procedure, meaning you can go home the same day. Steps in the procedure include:

• Incision: A femtosecond laser is used to make an incision in the eye with the assistance of built-in optical coherence tomography (OCT) imaging, which produces a magnified, high-resolution image of your eye.
• Cataract fragmentation: A femtosecond laser may be used to "soften" the cataract by breaking it into small pieces prior to the use of ultrasound vibration. This is helpful for dense cataracts to reduce the amount of ultrasound vibration needed.
• Phacoemulsification: Ultrasound vibration is delivered at a high speed to dissolve the cataract into tiny fragments that are gently suctioned out of the eye.
• Capsulotomy: A circular opening is created within the capsule (that holds the lens) to allow access to the cataract. When this step is completed with the femtosecond laser it allows for a precise circular shape, size, and centering over the cataract and precise placement of the new lens.
• Replacement: A new lens is inserted into the existing capsule.

Incision, cataract fragmentation, and capsulotomy are done with a laser device. Insertion of the new lens is done manually.

Laser cataract surgery is performed by an ophthalmologist (eye surgeon). Pain control is achieved with intravenous (IV, in a vein) sedation or oral (by mouth) sedation and local anesthesia.

Contraindications

You cannot have laser-assisted cataract surgery if you have dense corneal scarring or problems with the function of your pupils, such as if they do not dilate large enough.

These issues may be the result of a previous corneal or glaucoma surgery.

Potential Risks

There are some risks associated with any cataract surgery. Adverse effects of surgery include bleeding, swelling, infection, or damage to the eye. Vision can be permanently affected if these complications are not effectively and promptly treated.

Sometimes, a secondary cataract can develop several months after cataract surgery, potentially requiring treatment.

Risks with the laser portions of surgery include incomplete capsulotomy and loss of suction during the procedure. Overall, these risks are low and the laser portion can simply be skipped if needed.

Purpose of Laser Cataract Surgery

Having a cataract has been described as viewing the world through a dirty window. Some use the words cloudy, foggy, blurry, or hazy to characterize their vision. Removing a cataract and replacing it with an artificial lens can improve lost vision clarity.

Cataracts are diagnosed with an eye examination. You may be qualified for laser-assisted cataract surgery if your astigmatism will be corrected during the procedure and/or you need a special lens implant, such as a multifocal intraocular lens (IOL). These procedures require more precision than can be achieved with manual cataract surgery.

The decision to have a laser cataract surgery instead of traditional cataract surgery is based on several factors.

Some advantages of laser cataract surgery vs. traditional cataract surgery:

• Laser incision has been found to seal better than an incision made with a blade, which results in better healing.
• In laser cataract surgery, less energy goes into the phacoemulsification process than with traditional cataract surgery. This decrease in ultrasound energy may reduce inflammation and swelling of the front part of the eye (cornea) that can affect vision.
• Multifocal lens implants may lessen the dependence on corrective eyeglasses after surgery.

The selection of a laser method instead of a traditional method is not always obvious. Some studies haven't found an advantage or disadvantage in terms of the complication rate or healing of a laser cataract surgery compared to a traditional approach.

How to Prepare

Because Medicare and many insurance companies don't cover the cost of the laser-assisted method for all cataract surgeries, it's best to call and find out if the technique would be covered in your case.

In preparation for surgery, your healthcare provider will look at the structure of your eye with a non-invasive eye exam by dilating your pupils. You will have blood tests, including a complete blood count (CBC) and blood chemistry tests. The findings of the eye exam that detected your cataract in the first place will also be considered in surgical planning.

You will also have a chest X-ray and an electrocardiogram (EKG) as part of your pre-surgical testing.

Location

Your laser cataract surgery will be done in an operating room or a procedural suite.

You will go to your appointment from home and can go home on the same day as your surgery.

What to Wear

You can wear anything comfortable to your surgery appointment. Be sure to have your hair pinned away from your eyes. Do not apply cream or makeup to the face the day of the procedure.

Food and Drink

You may be permitted to eat and drink as usual before your procedure, or you may be asked to not eat and drink prior to the surgery. Be sure to listen to the surgery center's instructions on eating and drinking prior to surgery.

Medication

Your healthcare provider might ask you to stop or decrease your blood thinners in the days before your surgery. Sometimes, you might need to adjust other medications that you take as well.

What to Bring

You should bring a form of identification, your health insurance information, and a method of payment for any portion of your surgery that you will be responsible for paying.

Bring someone along who can drive you home after your surgery.

What to Expect on the Day of Surgery

Cataract surgery itself takes about 20 minutes. But between signing in, getting prepared for your surgery, and postoperative recovery, you can expect to spend between one to three hours at your appointment.

When you arrive at your appointment, you will register and sign a consent form. You will go to a pre-operative area where you will have your temperature, pulse, blood pressure, respiratory rate, and oxygen saturation checked.

You will have an IV line placed in your arm or hand or be given an oral medication. Your ophthalmologist and your anesthesiologist might see you before your surgery.

Before the Surgery

When you go to the operating room or suite where your surgery will take place, you will have anesthetic medication injected into your IV to make you drowsy and relaxed. You might fall asleep. Then you will have topical numbing eye drops put in your eye so you won't be able to feel anything and eye drops to dilate your pupil.

Your face will be covered with a surgical drape. The area around your eye may be cleansed, and you may have antibiotic drops placed in your eye.

During the Surgery

You will have your laser cataract surgery with your eye open. A small retractor will be placed around your eye to keep it that way during the procedure.

Your ophthalmologist will make a small incision in the periphery of your cornea with the laser. This incision should be about 2 to 2.5 millimeters (mm) long with a slight vertical and horizontal component.

Then:

• A femtosecond laser is used to break the lens into small pieces.
• For the capsulotomy, a small opening is made into the front part of the lens capsule that holds the lens. The capsulotomy is created in a nearly perfect circular fashion due to the OCT integration with the laser. This circular incision can be centered perfectly to hold the new lens implant in place.
• The eye is usually cleaned more thoroughly to create a sterile environment. A plastic drape is used to cover the area around the eye.
• The pre-softened cataract is then manually removed with phacoemulsification using a handheld ultrasound device.
• A new intraocular lens implant to replace the lens that was removed is inserted into the eye.
• Your surgeon might also create small incisions with the laser to prevent residual astigmatism from developing after your surgery.

The incision is self-sealing, so stitches are not needed. Your eye may be covered with bandages for protection.

Any IV anesthesia will be stopped and you will go to a recovery area.

After the Surgery

In recovery, you may receive pain medication as necessary. Your nurses will make sure you are comfortable and can walk and eat without difficulty.

If you aren't having any indication of complications (such as pain, bleeding, or swelling), you should be discharged to go home within a few hours after your procedure.

Before you are discharged, you will receive instructions about post-surgical eye care, when to make a follow-up appointment, and signs of complications to look out for.

Recovery

Generally, healing after laser cataract surgery takes several weeks, but you may be able to see clearly within a few days after your procedure. You might be able to drive within the first week, but wait for your healthcare provider to give you the green light before getting behind the wheel.

Prescription antibiotic and anti-inflammatory eye drops are generally given after surgery to assist with healing.

You will have an appointment to see your healthcare provider within a week. If you had an adjustable IOL placed, you will need to see your healthcare provider about two weeks after your surgery so that your healthcare provider can assess your vision and apply your prescription directly to your recently implanted lens with an ultrasound light.

You will see your healthcare provider again a few months later. You should be fully recovered after about three months.

Healing

You need to protect your eyes for several weeks after surgery while healing takes place. Don't get water or chemicals (e.g., hairspray, house cleaners) in your eyes. Wear sunglasses to protect your eyes from sunlight and from bright indoor light.

You may see bright lights or halos around your field of vision as you are healing. Your eyes may feel dry or gritty. You can use artificial tears for comfort according to your healthcare provider's instructions.

Coping With Recovery

As you are recovering, you may experience a gradual stabilization of your vision. This happens as the lens capsule shrinks to hold the new lens in place.

The slight vision changes in the months after your surgery can make it difficult for you to drive or even walk steadily. Take it easy and discuss any concerns with your healthcare provider, especially if you are having vision changes that are different from what you were told to expect.

Long-Term Care

You should expect to experience substantial improvement in your vision. Typically, about six months after surgery, your vision should be stable.

You may still need to wear glasses even after your surgery. But for most people, the calculated power of the new lens implant can decrease the need for glasses.

Sometimes astigmatism will arise, causing reduced vision after surgery. You may need to wear glasses to correct this vision problem.

Possible Future Surgeries

You can develop a cataract in your other eye or you can develop a secondary cataract, a cloudy membrane that forms behind the lens, in your surgical eye. If that happens, you would have to discuss your treatment options with your healthcare provider.

A secondary cataract can typically be removed with an in-office laser procedure called a YAG laser posterior capsulotomy that's performed if cloudiness returns.

Lifestyle Adjustments

In general, you should not have any limitations as a result of having laser cataract surgery. However, it's important that you have regularly scheduled eye exams so that your healthcare provider can identify vision changes early when they are still at a stage that is easy to treat.

A Word From Verywell

Laser cataract surgery is a method of cataract surgery. It is considered as safe as traditional cataract surgery, and there may also be some clinical advantages. But this approach isn't for everyone, and your health insurance may not cover it. You and your healthcare provider can discuss the best treatment approach in your situation.