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How relevant is it that Laser-Assisted surgery delivers half as much energy compared to manual?

Posted , 4 users are following.

BrianCyberEyes
BrianCyberEyes

I'm trying to determine if choosing femtosecond laser assisted cataract surgery (FLACS) has any real benefit. On one hand it's not really that significant of an additional cost, but I'm not quite sure about the benefits. Studies have it at a similar outcome as manual surgery and complications are similar, too (some issues are slightly less likely with one method, others slightly more).

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The biggest difference thrown around seems to be that during laser assisted surgery less ultrasound energy is required to complete phacoemulsification (about half) - but what does that mean in practical terms?

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Is it perhaps a significant difference if the patient has Glaucoma or Retina issues)?

0 likes, 7 replies

7 Replies

  • RonAKA
    RonAKA BrianCyberEyes

    Posted

    I have done a little research on this, but not a lot. What I found was that either laser or manual diamond blade incisions are equally effective if the surgeon is skilled in the use of the respective method. That would also suggest that a laser in the hands of a surgeon not skilled in the use or a manual diamond blade in the hand of a surgeon not skilled in the use may yield sub par results.

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    With the phacoemulsification step I have done no research on the differences. However, doing a complete and thorough job of this step can reduce the risk of floaters and PCO.

  • john20510
    john20510 BrianCyberEyes

    Posted

    Are you less likely to get floaters or PSC with the laser

    • BrianCyberEyes
      BrianCyberEyes john20510

      Posted

      As far as I've seen, studies comparing PCO after laser-assisted and manual surgery are mixed. Some results lean this way, some the other. You have to keep in mind, aside from the way the incision is made and the cataract softened, both methods require mechanical removal of the lens. If the surgeon doesn't do a good (manual) job of this step, the likelihood of PCO rises.

  • rwbil
    rwbil BrianCyberEyes

    Posted

    From everything I have read it makes no difference. These days they only make a small incision. But laser sounds less risky than a knife so good marketing.

    • BrianCyberEyes
      BrianCyberEyes rwbil

      Posted

      I understand that overall there's supposed to be very little overall difference in outcome, but I'm wondering specifically about the aspect and benefit of reduction of the applied ultrasonic energy through prior lens fragmentation with the laser.

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      As far as I can gather so far, this seems to result in a positive effect on endothelial

      cells preservation (more cells forming the thin layer lining the inside of the cornea die in the cornea during lens emulsification with an ultrasonic handpiece in the conventional approach due to more time of exposure). I just can't figure out how significant that is in real world terms, or if at all. Is it just a reduced chance to develop dry eye (temporarily I hope) and generarly shorter recovery time, no idea.

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      It doesn't seem to affect retina cells in this regard, which would be worrying to me, but my cornea is thin as well (517um), so maybe I would benefit from that aspect.

    • RonAKA
      RonAKA BrianCyberEyes

      Posted

      My understanding of the eye anatomy is that the natural lens is inside a capsule or bag which is well away from the cornea. The natural lens is broken up and removed from the capsule, and the IOL inserted back into the capsule. I think the PCO issue occurs within the capsule and again a long way from the cornea. I could be wrong, but I don't think cornea thickness is a risk factor for PCO. And a thickness of 517 is not all that thin, although it is toward the lower end of the normal thickness range of 520 to 540. It is well above the minimum required to form a flap for Lasik surgery, which is not recommended for thin corneas.

    • BrianCyberEyes
      BrianCyberEyes RonAKA

      Posted

      My understanding of the eye anatomy is that the natural lens is inside a capsule or bag which is well away from the cornea.

      I'm not sure why it affects corneal endothelial cells but loss of those does occur during the procedure regardless of method. Less with FLACS (which is explained by reduced phaco time and energy delivery) but not by a huge margin (I think 8% vs 11% according to one study).

      I think the PCO issue occurs within the capsule and again a long way from the cornea. I could be wrong, but I don't think cornea thickness is a risk factor for PCO.

      No, I wasn't referring to PCO. Corneal endothelial cells aren't related to it.

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