Femtosecond: Lightning Fast Laser For Cataracts

Femtosecond: Lightning Fast Laser For Cataracts

CREATED Jun 20, 2013

SCOTTSDALE, Ariz. (Ivanhoe Newswire) - The lens of the eye helps us focus, but as we age cataracts can develop. More than 22 million Americans over the age of forty have cataracts and that number is expected to rise by 50 percent in the next decade. Now, a new high tech laser is giving patients a new option to get their sight back.

Reading on her new Kindle would have been nearly impossible for Peggy Nardi last year.

"It was difficult. Even with the glasses," Peggy told Ivanhoe.

Her cataracts made it tough to see.

"That's the part that turns cloudy," Dennis L. Kilpatrick, MD, Medical Director at Scottsdale Eye Physicians & Surgeons, PC, told Ivanhoe.

She opted for a new option in cataract surgery that's being hailed the biggest advancement in 30 years.

"This is a tremendous breakthrough," Dr. Kilpatrick said.

Instead of cutting the cataract out with blades, surgeons use the femtosecond laser.

"The machine will make incisions in both the cornea and the lens itself," Dr. Kilpatrick explained.

It uses high energy pulses.

"The duration of the pulse is what gives it the name Femtosecond. You might have heard of a nanosecond, that's one-billionth of a second, but a femtosecond is actually one-millionth of a nanosecond," Dr. Kilpatrick said.

The bladeless approach improves safety for patients, cuts recovery time, and gives doctors a new level of precision.

"It's something no surgeon, no matter how good they are, can do with their free hand, not as well as the laser," Dr. Kilpatrick said.

"Color, color is fantastic," Peggy said.

For Peggy, it means seeing a brighter future with her great-granddaughter.

"I'm happy, happy, happy with it," Peggy said.

Femtosecond laser cataract surgery uses similar technology to Lasik and can also be used to fix astigmatism in cataract patients. It is FDA approved. The doctor said most of his patients feel their vision is much better about two weeks after standard cataract surgery. With the femtosecond laser, it's more like one week.


BACKGROUND: For people who have cataracts, it's like they are looking through a fogged-up or frosty window.  Cloudy vision makes driving at night, reading, and seeing facial expressions very difficult.   Cataracts usually develop slowly and don't disrupt eyesight early on. When cataracts first develop, stronger lighting and eyeglasses are needed to help patients deal with it.  Surgery is recommended if it begins to interfere with patients' usual activities.  Most cataracts develop when aging or injury changes the tissue that makes up the eye's lens.  However, some can be a consequence from inherited genetic disorders that cause other health problems.  (Source:www.mayoclinic.com)

HOW A CATARACT FORMS:  Cataracts is formed on the lens.  The lens is behind the colored part of the eye.  It focuses light that passes into the eye, producing sharp, clear images on the retina, which is the light-sensitive membrane on the back inside wall of the eyeball that acts like the film of a camera.  A cataract scatters the light when it passes through the lens, resulting in blurry vision.  Aging makes the lenses become less flexible, thicker, and less transparent.  Age-related changes to the lens will cause tissue to break down and clump together, clouding areas of the lens.  When the cataract continues to develop, the clouding becomes denser. (Source:www.mayoclinic.com)

TYPES:  There are three types of cataracts:

  • Cataracts that affect the back of the lens (posterior subscapular cataracts).  It starts as a small, opaque area and interferes with reading vision.
  • Cataracts that affect the edges of the lens (cortical cataracts).  It begins as whitish, wedge-shaped streaks on the outer edge of the lens cortex.
  • Cataracts you're born with (congenital cataracts).  Some people develop cataracts early or are born with it.  Such cataracts could be a result form inherited diseases or a mother having an infection during pregnancy. (Source: www.mayoclinic.com

NEW TECHNOLOGY:  Cataract removal entails removing the cloudy natural Crystalline Lens of the eye using a technique called phacoemulsification.  It requires many manual steps.  In order to have a more precise procedure, doctors are using what is called femtosecond lasers. The femtosecond laser has already been successful for a number of years in laser eye surgery for the laser vision correction of common vision disorders like astigmatism, nearsightedness, and farsightedness.  The advantage of using femtosecond laser assisted cataract surgery is that it allows the conversion and consolidation of the many skill intensive steps of cataract removal into a more predictable procedure.  Surgeons believe the femtosecond laser will be useful for: creating "perfect" incisions in size and architecture, an important step to have the incision seal properly without stitches; creating a perfectly centered and sized "capsulotomy," which is the opening prepared in the front of the Crystalline Lens through which the cloudy material is removed; liquefying and softening of "chopping" the Crystalline Lens, in order to allow the cloudy material to be removed; and creating the possibility of precise corneal incisions.  LenSx Lasers, Inc. has received Food and Drug Administration (FDA) approval to market the first generation of femtosecond laser for Cataract Surgery in the United States. (Source:http://www.aboutcataractsurgery.com/femtosecond-laser-cataract-removal.html)


Dennis L. Kilpatrick, MD, Medical Director at Scottsdale Eye Physicians & Surgeons, PC, talks about a new breakthrough in cataract surgery.

We're talking today about the femtosecond laser. How big of a breakthrough would you say this is in cataract surgery?

Dr. Kilpatrick: This is a tremendous breakthrough in cataract surgery. The last big breakthrough like this was twenty or thirty years ago when we changed the technique we use, but this is tremendous.

What is the difference?

Dr. Kilpatrick: The femtosecond laser uses a laser to make all the incisions, and in cataract surgery there's several incisions you make and they need to be really precise so you can get a good visual result. The femtosecond laser makes them so incredibly precise and reproducible each time that it will help with our patients' outcomes. It will help with the continuity so we know what to do each and every time with our patients.

Is this something you would use instead of cataract surgery?

Dr. Kilpatrick: It's a way to make the incisions during cataract surgery. So, it's just a new tool we use while we're doing cataract surgery.

Do you know more about the science behind it as far as how many pulses and that type of thing?

Dr. Kilpatrick: The number of pulses will vary but the duration of the pulse is what gives it the name femtosecond. You might have heard of a nanosecond, which is one billionth of a second, but a femtosecond is actually one millionth of a nanosecond. The femtosecond is a very brief duration so you use a lot of them to make an incision in different parts of the eye.

So it has to be very precise?

Dr. Kilpatrick: Correct.

What has been the response of patients?

Dr. Kilpatrick: They love the aspect that it's safer and more precise. Everybody would do it if they could, but there's an expense to it and so not everybody can afford it.

Is it covered by insurance right now?

Dr. Kilpatrick: It's not covered by insurance; so it's an extra out of pocket expense.

As far as the safety and efficacy of it, how superior would you say this is to your typical surgery?

Dr. Kilpatrick: What's nice about it is the reproducibility of it. In traditional cataract surgery, we've used metal blades and so on to make incisions to the cornea and different types of instruments to make the incisions in the lens of the eye and in the cataract of the eye. Those incisions just aren't as precise. We like to make a certain kind of incision that has a step to it so it seals properly and then you don't need to use sutures. The laser will make that exact stepwise incision the way you want it every time.

How does the recovery time compare?

Dr. Kilpatrick: It will be a quicker recovery time with those incisions that are so precise. The laser also will make incisions that correct astigmatism and we can do those by hand now, but when you do it with the laser it's so precise and perfect it will be a much better outcome.

Can you quantify that? How long would it take traditionally to recover versus now?

Dr. Kilpatrick: The recovery time could just be a few days earlier than with traditional cataract surgery. Cataract surgery recovery is really quite quick anyway, but probably a little less discomfort as far as the incision goes.

Are there any other advantages that you see with this new technology?

Dr. Kilpatrick: I believe it has a safety advantage. We're not dealing with blades and sharp objects around the eye, instead we're using lasers to make all the incisions.

This is the same technology that they use with Lasik, right?

Dr. Kilpatrick: It is, with a certain step in the Lasik. The step that makes the flap on the cornea; it's really the same laser that does that.

Is there anything else that you wanted to say?

Dr. Kilpatrick: It can't be used for everybody, like if a patient has glaucoma, if they have a scar on their cornea, or things like that. So it can't be used for a hundred percent of the patients.

It can help to fix astigmatism as well?

Dr. Kilpatrick:  It sure can.

Is the number of people getting cataracts supposed to increase over the coming decades?

Dr. Kilpatrick: That's true. As the baby boomers reach retirement age, they all develop cataracts and we all have two eyes. Cataract surgery is one of the number one surgeries done on Medicare patients now, so to do it in a safer and more precise way is a huge plus for all those baby boomers out there.

Can you explain how cataracts are formed?

Dr. Kilpatrick: Sure. An eyeball is just a camera; you've got some focusing lenses up in front, you've got the film of your camera in the back.  One of those lenses, the one that's tucked in right behind your iris, turns cloudy; it turns cloudy in all of us as we age. If it gets cloudy enough that it's affecting your vision or causing glare, we call that a cataract. That's what we are removing when we do the cataract surgery.

So the whole lens is taken away instead of cleaned off, correct?

Dr. Kilpatrick: Nowadays we don't take the whole lens out; we make an opening in the top of it. That's where the femtosecond laser makes a beautiful, perfect round opening every time, exactly the same size. The femtosecond laser also pre-chops the cataract up so you can bring it out easier with much less suction and power. The femtosecond laser actually makes the incision in the cornea, in the top of the lens, and in the cataract itself to help in removing it, so it makes the surgery go a little faster too.

Is the laser preset? Do you do pre-measurements or is it one size fits all?

Dr. Kilpatrick: The way the laser works is it has to dock to the eye. I know that doesn't sound very appealing but it has to stabilize the eye. You actually have this little docking ring that attaches to the eye and the laser comes down and fixes everything nice and solid. Then the laser does a series of measurements with this device called an OCT. It's like an ocular CT scan and it can measure the depth of where the cataract is living and that way it can make the incisions at the perfect places. It takes three minutes typically for the femtosecond laser to do its thing.

What is it like with this particular laser? How quickly does the eye repair itself?

Dr. Kilpatrick: The eye repairs itself really quite quickly. Most of my patients are driving on their own by the next day and they're usually quite comfortable. A lot of my patients can still work the next day whether it's done with the femtosecond or not, but the healing time would be a little bit quicker with the femtosecond laser.

Are they the same basically?

Dr. Kilpatrick: When we do cataract surgery and make that opening in the top of the lens in order to take the cloudy material out, we like that opening to be the same size every time. It helps the implant lens we place in there to center better. The femtosecond laser will allow us to do that. It will allow me to be a better surgeon because the opening the laser makes for me will be perfectly precise and round every time. It's something that no surgeon, no matter how good they are, can do free hand near as well as the laser.


Dennis L. Kilpatrick, MD
Medical Director
Scottsdale Eye Physicians & Surgeons, PC. 
(480) 994-1872