Cutting Through the Cloud of Laser Cataract Surgery

Which is better: traditional cataract surgery or laser cataract surgery? Dr. Michael Pennachio sorts through the facts in this blog. Read on!

“Femtosecond laser-assisted cataract surgery did not yield better visual or refractive outcomes than conventional phacoemulsification cataract surgery. Intraoperative complications were similar and low in both groups. Postoperative complications were lower in conventional phacoemulsification cataract surgery.”1

That was the conclusion of the largest study to date comparing laser cataract surgery to standard cataract surgery. The study looked at results from 2,814 laser assisted cataract surgeries and 4,987 conventional cataract surgeries.

“I was a scientist long before I became an ophthalmologist,” says Dr. Pennachio. “It is important for physicians to evaluate the basic science behind treatments as well as the results of studies. That’s exactly what I’ve done to answer the question, ‘Is bladeless cataract surgery better?’”

In Dr. Pennachio’s research, he has found that the physics and technology behind laser assisted cataract surgery incisions are not living up to expectations. The laser incisions are simply not superior to those made by the advanced diamond blades available today.

Reasons Why Traditional Cataract Surgery is Preferred

Many laser cataract surgeons have abandoned using the laser for the corneal incisions because:

  • The use of a blade or another instrument is still often required to open the laser incision.
  • The location of the laser incision is often not in the optimal location compared to a diamond blade incision.

The opening of the surface layer of the cataract (capsulotomy) by the laser is also a problem when you understand the physics behind the procedure:

  • The capsulotomy is indeed more reproducible in size and shape by using a laser compared to conventional surgery, but it can result in a weaker capsule opening. The more consistent size and shape of the capsulotomy has not resulted in better vision outcomes.
  • The use of the laser for correction of astigmatism has been replaced in most cases by using astigmatism correcting intraocular lenses. These lenses provide superior results.

Advantages Not Proven by Science

Proponents of laser cataract surgery will tout specific advantages of this technology. However, their claims are not supported by science such as less post-operative discomfort, shorter surgery times and faster recovery from surgery.

So why are cataract surgeons recommending laser cataract surgery? “I can only paraphrase what a very respected cataract surgeon stated at an ophthalmology conference panel discussion after the release of the study mentioned at the beginning of this blog: ‘When will surgeons tell patients we are recommending laser cataract surgery because we like to do it,’” says Dr. Pennachio.

1Manning, S. “Femtosecond Laser-Assisted Cataract Surgery Versus Standard Phacoemulsification Cataract Surgery: Study From the European Registry of Quality Outcomes for Cataract and Refractive Surgery.” Source:

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