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New laser method could revolutionize cataract surgery: the femtosecond laser will enable safer, more precise surgery.

About 3 million cataract procedures are performed annually in the U.S., making it one of the nation's most common surgeries. The procedure corrects a vision problem many older Americans develop (statistics suggest that more than 22 million adults over age 40 have cataracts, and that number is expected to rise by 50 percent in the next decade).

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The benefits that can result are underlined in a recent study, and now a new approach that employs bladeless laser cutting technology could make the surgery even safer. Already employed for laser-assisted in situ keratomileusis (LASIK, which is used to correct nearsightedness and farsightedness), the LenSx Femtosecond laser is the first laser approved in the U.S. for the lens fragmentation that is an element of cataract removal.

OVERALL HEALTH BENEFITS. Cataracts develop when proteins in the lens of the eye cluster together, forming a clouded area that starts out small but gradually spreads, causing the lens to become opaque. This compromises the images we see, with cloudy areas adjacent to areas of relative clarity.

At this point your eye doctor may recommend surgery to remove the cataract. Having the procedure could benefit far more than your eyesight. According to a recent study (Ophthalmology, Sept. 3013) including 354 adults age 49 and older, those who had cataract surgery had a 40 percent lower long-term mortality risk. Other research indicates that cataract surgery can reduce the risk of falls and hip fractures in older adults.

"Our finding complements the previously documented associations between visual impairment and increased mortality among older persons," says lead researcher Jie Jin Wang, PhD, of Australia's Westmead Millennium Institute. "It suggests to ophthalmologists that correcting cataract patients' visual impairment results in improved outcomes beyond that of the eye and vision, and has important impacts on general health."

UNCLOUDING YOUR VISION. Standard cataract removal surgery requires that small incisions be made in the cornea (the transparent front part of the eye), and the lens capsule (a clear membrane that surrounds the lens) using a hand-held diamond or metal blade. A tiny probe is inserted through the incisions--the probe emits ultrasound waves that break up the natural lens into small pieces, which are removed using suction. A clear plastic artificial intraocular lens (IOL) is then inserted into the lens capsule, to become a permanent part of the eye. You can choose from a monofocal lens, which allows for fixed distance vision (covered by Medicare), or a premium IOL, which enables distance and near vision (the latter is not covered by Medicare, and can cost upwards of $5,000).

The LenSx Femtosecond could simplify this procedure. Using computer technology, Femtosecond creates a precise surgical plan via a sophisticated 3-D image of the eye, and utilizes a high-energy pulse to make bladeless incisions. It also cuts into the natural lens, softening it for removal. After completion of the laser procedure, the patient is shifted to the operating room, where the laser-created corneal incisions are opened and the fragmented lens is removed, to be replaced by the plastic lens.

MORE PRECISION, LESS TRAUMA. Arturo Betancourt, MD, president and medical director of Baltimore Washington Eye Center, says the Femtosecond laser al lows the consolidation and conversion of the many skill-intensive steps of cataract removal into a more predictable procedure. "Cataract surgery is a technically complex type of eye surgery requiring tremendous surgical skill for a number of steps that we have performed manually until now," notes Dr. Betancourt.

"The Femtosecond laser provides the added benefits of bladeless laser cataract surgery to deliver a safe, more precise and even more gentle eye surgery."

The laser method has been shown to reduce the average time and energy required to break up and remove the natural lens by approximately 50 percent. This should make the overall procedure less traumatic to the eye. Indeed, a study in the Journal of Refractive Surgery, June 2013, suggests that the Femtosecond laser procedure causes less corneal swelling in the early post-operative period, which may indicate less collateral damage to corneal cells.

Douglas K. Grayson, MD, FACS, attending surgeon at the New York Eye and Ear Infirmary, Manhattan Eye, Ear and Throat Hospital and Lenox Hill Hospital, and a surgeon with Omni Eye Services, believes that overall Femto-assisted surgery is a major advance. "Femtosecond laser cataract surgery is, in my experience, far superior to traditional manual cataract surgery," he says. "Cataract softening allows the surgeon to use far less ultrasound energy in the eye, which is safer for the patient. Following laser-assisted surgery there is much less swelling and inflammation than with manual cataract surgery."

LONG-TERM EVIDENCE NEEDED. It is important to keep in mind, however, that while there is promising research indicating that laser cataract surgery may improve visual outcomes, long-term data is not yet available to substantiate claims that it is safer.

THE VIEW FROM DUKE

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ROBIN RAUL VANN, MD, Assistant Professor of Ophthalmology; Chief, Comprehensive Ophthalmology Service, Duke

Laser Surgery: New Level of Consistency, Precision, Safety

"As the number of individuals with vision-impairing cataracts increases in the United States, it will become critical for cataract surgeons to be able to perform cataract surgery safely and efficiently. In addition, surgeons need precise reproducible measurements and techniques to offer newer-technology intraocular lens implants for increased spectacle freedom after surgery. Laser-assisted cataract surgery will introduce a level of consistency, precision, and safety to cataract surgery that we have never been able to accomplish with our manual methods of cataract surgery. As we continue to develop this technology, we hope to see the evidence of the long-term safety, and improved visual outcomes."
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Title Annotation:INTERNAL MEDICINE
Publication:Duke Medicine Health News
Date:Nov 1, 2013
Words:932
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