Laser Eye Surgery

What is laser eye surgery?

Well that depends on what type of laser eye surgery we are talking about. Lasers are used in many different types of eye surgeries, including LASIK and PRK, glaucoma (laser trabeculoplasty (SLT) and iridotomy), after cataract surgery film YAG capsulotomy, laser cataract surgery (femtosecond laser), and a variety of retinal lasers. And this doesn’t even include using lasers to perform eyelid surgeries! All of these laser eye surgeries are carried out on different tissues in the eye with different laser types and powers, so it’s important to know what you are talking about when discussing laser eye surgery!

When patients see ads for laser eye surgery it is commonly in reference to laser cataract surgery using a femtosecond laser. This is a relatively new technology and as such is being heavily promoted by industry. While many eye doctors and cataract surgeons were excited about this technology, to date it hasn’t delivered the promised benefits to patients compared to our standard cataract surgery techniques. Additionally, the laser is extremely expensive and ultimately patients bear these costs. While I did trial the femtosecond laser for laser cataract surgery, I found that it did not deliver superior results in my hands and as such I do not think it is worth patients paying for it. As such, I currently do not use a laser when I perform cataract surgery here in Traverse City, MI. This view, that the laser does not provide superior vision results, is supported by the best and most rigorous studies performed across the country. With hardly any exceptions, the studies that show a benefit to laser cataract surgery are industry-sponsored and are thus subject to significant financial conflicts of interest.

It’s unfortunate that for whatever reason the general public equates new technology (such as the use of a laser) to increased safety. This idea has been disproven time and again as new technologies are ultimately found to be more dangerous than tried and true methods. There have been a slew of recent news stories regarding this phenomenon as it relates to minimally-invasive and robotic surgery for cervical cancer.

It’s also important to note that during laser cataract surgery the eye surgeon is still using the same instruments and entering the eye just as he or she would during standard cataract surgery. The laser just augments and partially automates some of these steps. And as the studies have shown this automation has not translated into superior results for patients, which agrees with my personal experience. This is largely due to the fact that modern cataract surgery has a very low complication rate (so there’s not a ton of room to improve) and when a complication occurs, it’s usually not from something that the laser could have prevented. Additionally, there is evidence that using the femtosecond laser for cataract surgery can actually increase surgical complications and surgeon difficulty. Two examples include pupil constriction following femtosecond cataract treatment (a smaller pupil is more difficult to operate through) and the creation of a serrated “postage-stamp” edge to the laser capsulotomy made in the capsule surrounding the cataract that is more prone to splitting than an opening made manually.