Refractive Surgery Information

The Patient’s Perspective

In my career, I have learned to always pay attention to the patient’s perspective; what do they want? Especially in refractive surgery, it is usually the patients’ preferences that ultimately drive the market and even steer what we do surgically. As an example, we were never able to show LASIK gave significantly better final results than PRK, but because the healing was quicker, and with less discomfort, the patients selected LASIK. I believe the same process will emerge in Laser Cataract Surgery.

We have had the LenSx laser in Houston now since February of 2010, one year as I write this article, in a commercial, office based surgical center. We have studied the science of the technique, refined the hardware and software, and generally learned better how to use the device with several hundred cases. In addition, we have witnessed our patient’s experience with this laser as the vast majority of them choose it for their surgery and pay more for it.

One of the first things I learned was how rapidly patients accept and chose Laser Cataract Surgery. Immediately I saw that this procedure needed less explaining, education or counseling of any new technology I have ever introduced into our clinic. We all have the experience of the first time we use a new technology with our own patients; your first LASIK, first wavefront ablation, first presbyopia correcting IOL, and so on. All new tecnologies seem to take a different amount of education to the patient for them to be able to make their informed choice. So why is laser cataract surgery such an easy choice for them?

Patients want two things with eye surgery. They want safety, of course, first then they want the best possible glasses free vision and as soon as possible. Laser cataract surgery helps to deliver both.

I believe the laser offers important safety advantages over manual cataract surgery. We have shown using that the laser to “prechop” the nucleus decreases both phacoemulsification time and power. This leads to less endothelial cell loss. Comparing my laser cases’ endothelial cell counts, to published series of post cataract endothelial cell counts, we can show a lower cell loss with the laser. This could mean better, quicker results and fewer complications.

There are advantages for many of our more difficult cases as well. There is added safety in a “no touch” capsulorhexis in cases of compromised zonules, traumatic cataracts, and psuedoexfoliation. With the laser, you do not have to stress the zonules making the capsulorhexis or stress them chopping the nucleus. This could lead to fewer dislocated lens and even dropped nuclei. The laser helps as well with white cataracts, dislocated lens and fibrous capsules. We are better able to optimize our wound dimensions and construction, and do it time after time with the laser. This will lead to fewer wound leaks, and improved lens stability. Better wounds could actually lower infection rates and lower astigmatism, so again, fewer secondary procedures with the associated additional risks.

Further, we have shown that controlling and standardizing the size and centration of the capsulorhexis increases the accuracy of the spherical component of the IOL. The capsular contraction is more uniform so the IOL ELP is less variable. We have excellent results as well with treating astigmatism with the laser at the time of surgery. Thus laser cataract surgery contributes to a higher rate of glasses free post op vision, and sooner after surgery, in both sphere and cylinder. Of course, if the lens is more accurate, then there will be fewer IOL exchanges and fewer secondary procedures like LASIK or PRK, which adds to safety as well.

In our clinic, patients are choosing, and paying for, these safety and efficacy benefits. I have never seen patients accept a new technology so quickly. The laser simply adds value that the patients readily, easily and confidently understand. They simply “get it” at the word “laser”.

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