What is the best method for cataract surgery?

Doctor's Answer

The current gold standard of cataract surgery is done via phacoemulsification with micro-incisions as small as 1.8mm to 2.2mm. In recent years, the use of femtosecond lasers in cataract surgery has been introduced for the hope of improved precision in certain steps of cataract surgery.

For many surgeons, the view is that femtosecond surgery, though it may be applied to most cases of cataract surgery, has a comparative advantage to non-laser techniques only for specific types of cataracts (e.g. mature dense cataracts).

In the majority of cases, cataract surgery results are excellent with or without the use of femtosecond laser. Hence, many surgeons are rather selective as to who should have surgery using a femtosecond laser as it does entail greater costs and lengthens the overall time of the surgery for the patient.

There has been much hype lately about touting the laser as vastly improving results of cataract surgery and that it is a “bladeless” technique. In many ways, the laser simply does the job of the steel blade. Hence, the term “bladeless” is rather meaningless in this context as both techniques require incision wounds to be created and for the surgeon to enter the eye. As a result, with or without the femtosecond laser, the surgeon still has to work within the eye and the risk of complications are not removed. To most skilled and experience surgeons, little or no improvements in their surgical results have been seen with the use of femtosecond lasers in cataract surgery.

Also note that all femtosecond lasers in the market currently are still in their first generation. Could technology in femtosecond lasers improve to make a more compelling case for greater widespread use? Yes, certainly. So I too am eagerly awaiting to review the capabilities of the second generation of femtosecond lasers.

I applaud your interest in finding the best possible treatment for your grand mother. My advice to you is to seek out the best surgeon you trust and let them advise you on the best course of action. The best direction may not always mean the highest cost option which some may lead you to believe.

I wish you all the success with your grandmother's treatment.

Dr David Chan

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