Femtosecond: lightning fast laser for cataracts

A new bladeless approach to cataract surgery is being hailed as the field’s biggest advancement in 30 years.

Cataracts develop on the lens of the eye, and they affect more than 22 million Americans over the age of 40. However that number is expected to rise by 50 percent in the next decade.

Those with cataracts know just how much they affect daily life. Peggy Nardi bought a new Kindle, but her cataracts made it nearly impossible to read.

“It was difficult,” said Nardi. “Even with the glasses."

But a new high-tech laser is giving patients like Nardi some options.

"This is a tremendous breakthrough,” said Dr. Dennis L. Kilpatrick, the medical director at Scottsdale Eye Physicians and Surgeons.

Instead of removing the cataract with blades, surgeons use the Femtosecond laser.

"The machine will make incisions in both the cornea up here and the lens itself," said Kilpatrick.

The laser uses high energy pulses.

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

This new 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 that free hand near as well as the laser," said Kilpatrick.

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

"Color, color is fantastic," Nardi said.

Femtosecond laser cataract surgery uses similar technology to Lasik and can also be used to fix astigmatism in cataract patients.

The surgery is also FDA approved.

Kilpatrick says most of his patients feel that their vision is much better about two weeks after standard cataract surgery.

With the Femtosecond laser, it only takes about a week.


REPORT: MB # 3626

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 are 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 them. 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)

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Dennis L. Kilpatrick, MD
Medical Director
Scottsdale Eye Physicians & Surgeons, PC

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