Risks of Laser Cataract Surgery

Dr. Gary Foster- Fort Collins & Loveland, CO

Risks of Laser Cataract Surgery with the femtosecond cataract laser

The Risks of Laser Cataract Surgery

Laser cataract surgery using the femtosecond laser offers some safety advantages over traditional cataract surgery due to the detailed digital imaging and precision of the laser.  As with any surgical procedure, however, there are still risks.  This blog outlines some of those important risks or complications following laser cataract surgery for to consider.

Eye Inflammation

Studies have shown that there is less inflammation in the eye after laser cataract removal than with basic eye surgery, but there is still some inflammation.

You will be on two different anti-inflammatory drops to reduce inflammation.

Uncontrolled inflammation can cause swelling in your retina. If swelling develops in your retina, it can distort your vision.  We would need to refer you to a retinal specialist to treat this if it occurs.

Corneal Swelling

Laser cataract surgery is more gentle on the cornea than standard cataract removal techniques on average so corneal damage is less common but can still occur in rare cases.

During your pre-operative evaluation, I’ll be carefully looking for any risk factors which may pre-dispose you to corneal swelling after your surgery.

If swelling develops, it blurs your vision.  Usually it resolves quickly without treatment with a good return of visual clarity.  Other treatment options are available if it persists. I’d prefer to avoid it all together.

Laser Interface Suction

To prevent your eye from moving and to ensure precise results, the “laser interface” physically touches your eye and holds on by creating gentle suction.

It is only in that position for about 40 seconds.  But a strong movement of your head or eye could break the suction.  This would require that the surgery pause while the suction is replaced or in some cases that the case be postponed or converted to standard eye surgery.  The suction is mild, but can cause some redness of your eyes for the first week after eye surgery.

If your eyes don’t open very wide or if the white part of your eye is puffy, it may be difficult to get the laser into the correct position for the surgery.  In this case, the surgery would have to be postponed or done in a standard fashion.

If there is something that would block the path of the laser light, like corneal scars or folds, then the laser would not be able to treat what lay behind the obstacle.  This could create a scenario where that part of the surgery would need to be completed by hand.

Experienced Laser Cataract Surgeon

Laser cataract surgery is technically different than standard traditional eye surgery.  A crucial part of both laser cataract surgery and standard surgery is creating a perfectly round opening, called the capsulorhexis, in the thin outer coating of the cataract.  It is through this opening that the cataract is removed.

One study from Australia showed that surgeons that were just learning femtosecond surgery had more trouble obtaining a perfect capsulorhexis and removing the entire cataract than those with experience so it is recommended that you find an eye surgeon with extensive experience.

We were one of the first in the U.S. to offer the benefits of this technology.  Your eye doctor may have performed a number of basic cataract surgeries, but could be just learning how to do the procedure.  Surgeons have to learn somewhere to gain experience, but they don’t have to learn on you.

Residual Astigmatism

One advantage of this technology is that the femtosecond laser can reshape your cornea while it is helping remove the cataract.  The laser does a very good job of this for most patients, but no method of astigmatism correction is perfect.

You may still retain part of your astigmatism or the direction of our astigmatism could change.  If this occurs you will need to discuss alternative methods of reducing your astigmatism.

Standard Cataract surgery vs Cataract Laser Surgery

There are some risks associated with cataract surgery in general, no matter how it is performed.  These include risks like infection, detached retina and hemorrhage.

A number of tests are performed to help identify the correct power of intraocular lens for your eye.  These measurements are good but not perfect resulting in some amount of target error.

Most are very close to ideal while others are more near or farsighted than they would prefer.  This improves the accuracy of these results, but still falls short of perfection.

The risks of not having laser cataract surgery

Femtosecond cataract surgery for sun and headlight glare

Laser Cataract Surgery for sun and headlight glare

One thing is certain.  If you have a cataract, it will get worse over time.  If you do not feel like your life is affected by your cataracts then waiting until they get worse may be the best decision for you.

Within reason, it doesn’t get harder to remove the cataract if you wait a bit longer.  However, if your cataract is significant, then your blurry vision could put you in harms way.

Consider how it would feel to crest the top of a hill and have the sun hit you in the eyes.  The glare from your cataracts could make it impossible to see the road clearly for a few moments.  If this is happening, then for the sake of the squirrels and small farm animals, please get your cataracts repaired.

Night driving is another activity that often feels less safe with cataracts.

This list is representative of the risks of cataract laser surgery, but it is not comprehensive.  Your eye surgeon will discuss your specific risks with you at your consultation.  If I can help answer any other questions for you, please schedule a time to meet with me or use the contact section of the blog to send me a note.

 

Comments

  1. I am legally blind in one eye and have had cataract surgery in it using a Bouch & Lomb lens. My doctor want to do the other eye with the same Bouch & Lomb lens. It is a synthetic lens of which I read should not be used if a possiblity of vitreo=retinal surgery down the line. Years ago I had a posterior vitreous detachment, still can see flashes of light at times, and was left with floaters. Also in the report at that time was that my eye disc has a deeper cup than my right eye. Not sure If I should have this lens. Went to see another doctor who uses an Alcon lens, which is acrylic he also mentioned laser surgery would be safer for me. Not sure what lens to go with or regular surgery or laser surgery? I am very concerned because it is my only good eye. I use glasses for close work now. My distance vision is getting a little worse. One Doctor did say after after checkup he couldn’t believe I see as well as I do with the cataract. I have a lot of problem driving at night however. Would like answer. Don’t know which lens or surgery would be better. Both doctor seem to be good.

    • Carol: The silicone lens from b & L is a good lens. Doctors avoid using silicone IOLs if there is reason to believe that serious retinal work is likely in a patient’s future. You have already had a PVD and did not develop retinal problems so the likelihood of a retinal detachment requiring silicone oil probably very small, but you should confirm this with your eye doctor. I prefer the laser to standard cataract surgery and the acrysoft acrylic lens is my lens of choice for most patients.
      God Bless,
      Gary Foster

  2. Shirley vertullo says:

    I recently had laser cataract surgery causing an artery Iin the optic nerve toblow causing edema inflammation loss of my good per surgery vision only reason to have cataracts removed was to eliminate excessive glare now I’m left with painful t times cloudy vision while the condition is self healing how long do symptoms persist what treTment is best to restore the good vision I had
    Thank you for any advice you can give me
    Shirley

    • Shirley:
      I am so sorry you are having these problems. I am not 100% sure of the problem you are referencing based on your information, but it sounds like you have AION (Anterior Ischemic Optic Neuropathy). If that is the case, then AION can happen with or without cataract surgery and it would be a very very rarely association with cataract surgery. In AION, one of the blood vessels that feeds the optic nerve with energy occludes. This chokes that part of the nerve so it swells. The swelling causes the blood vessels on either side of this area to also occlude, etc.
      Laser cataract surgery tends to decrease the amount of phaco energy needed to complete the cataract surgery, decrease the amount of fluid run through the eye, and minimize the amount of time the pressure inside the eye is elevated during the surgery. All of these would tend to make this complication less likely with laser cataract surgery than with standard cataract surgery in my opinion.
      It is also possible that you are describing a branch vein occlusion or a hypertensive type diabetic nerve. These last two are more likely to improve than an AION. I am not aware of any effective treatments for AION other than following to see if the body can heal it.
      All of my supposition could be completely off base, underscoring the importance of seeking a clear diagnosis from your eye doctor so you can better predict the future for this suffering eye.
      God Bless,
      Gary Foster

  3. I have a very small bubble on my retina that I am told is aged related macular degeneration. It has been stable for more than four years. I am scheduled to have laser cataract surgery on this eye. Is there any additional risk to my retina with laser surgery as compared to the standard cataract surgery? .

    • Carole:
      Sorry that you have the macular troubles. I am not aware of any additional risks. There are several papers showing less macular edema with laser cataract surgery as compared with standard cataract surgery. This could mean that there would be less risk, but we don’t have enough data to know for sure yet.
      God Bless with your upcoming surgery.
      Gary Foster