In the eye magnified on the computer screen, a thin circle suddenly appears around the pupil and a cross appears in the dark cataract beneath as if it is the middle of a bomb sight.
“The laser has softened the center of the cataract and cut it into four pieces,” said Dr. Bradley Bertram of Eye Physicians and Surgeons of Augusta.
In about a minute, the laser has also cut a precise, 5-millimeter, circular incision in the top of the capsule surrounding the clouded lens in the eye and cut two small incisions on opposite sides of the inside of the cornea to help correct astigmatism.
The laser system, LenSx, cannot be promoted yet as better than manual cataract surgery because there is no approval to do that and there is no published research from the United States showing improved efficacy, Bertram said. That research is ongoing, and the Augusta clinic is still reviewing the data on its more than 100 laser cataract cases so far, he said,
But from his experience, Bertram said, “I would say the advantages are the precision of the corneal incisions to correct astigmatism as compared to what I can do with my hand.”
It also can make a more precise and consistent opening in the top of the capsule holding the lens.
The machine made a 5-millimeter opening. While working on an earlier patient and carefully tearing open the capsule by hand, Bertram ended up with about a 4-millimeter opening.
“After doing this 18,000 times, I’m still not as good as the laser,” he joked.
If the opening is off a few millimeters in size, it can affect how the implanted lens will fare.
“If the (incision) is too large, the implant can shift forward, and the patient ends up nearsighted,” Bertram said. “If the (incision) is too small, the implant can shift backward and the patient winds up farsighted.”
The laser also softens the cataract, which could mean that less ultrasound power is needed to break up the cataract to remove it. That could mean potentially less damage, less swelling and quicker healing.
A downside to the laser system is the cost, about a half-million dollars. There is added time to the surgery, too, because it is now two procedures – the laser part and the traditional manual removal of the cataract and the placement of the lens implant.