Ultrasound vs. laser … Is cataract surgery not always done with laser?

There is a common misconception that all cataract surgery is done with laser.  Perhaps because the procedure is so quick and efficient or that there is so much advertising for LASIK refractive surgery… but patients often confuse the two surgeries and how the procedure is done.

The two main clarifications that I make with patients are:

1] Cataract Surgery is not LASIK.   LASIK is a laser-based procedure to reshape the cornea (the outer surface) of the eye.  Cataract surgery removes the cloudy lens from inside the eye and replaces it with an implant.   In some circumstances these two procedures can be combined (not concurrently) but they are different procedures requiring different technologies and surgeon skill sets.

2] Cataract removal surgery typically uses ultrasound energy (not laser) to break up the natural lens to remove it.  However, laser energy can also be used for this purpose.  This is an increasingly popular option … but it is not widely done in this region - Ontario. 

What are the pre-surgery eye measurements required for implants?

There are several eye measurements that a surgeon will take into consideration for your surgery.

1] The refraction (your glasses prescription)
2] The curve of the cornea
3] Measurements of the length of the eye (ultrasound)

These are all used to determine the best implant.   In this region, some of these measures are come with extra charges.  I always recommended these measurements be taken (even if a charge) because it does improve the accuracy of the final post-surgery glasses prescription (or lack thereof!).

Should I get a bifocal / multifocal implant?

Some cataract surgeons will offer bifocal / multifocal implants.  These lenses ideally eliminate the need for distance and near glasses post-surgery.   Your case is unique and needs to be discussed with your eye care team but these are the general points that I speak to patients about regarding this premium option:

1] needs to be bilateral to work well [a] do both eyes on a short timeline and [b] consider if you lost vision from one eye in the future
2] good for general near vision but not detail.   Readers may still be required
3] may add to night glare
4] tremendous freedom
5] In my opinion, people who have previously successfully worn multifocal contact lenses make the best candidates
6] significantly more expensive

I am confused about the enhanced implant and procedure options available for cataract surgery

Basic Cataract Surgery (lowest cost to patient or payor)  This procedure is usually hospital-based.  It is safe and effective and provides the medically necessary cataract surgery procedure with standard lens implant. 

Enhanced Cataract Surgery This typically hospital-based surgery is the same procedure as basic (above) however the lens implanted & the calculations around lens selection are improved.  The enhanced procedure often leads to a better refractive result post-surgery with less night glare. (no astigmatism correction)

Enhanced Cataract/Refractive Surgery  This procedure is done at a private facility that also offers LASIK.  There is great emphasis on achieving the best distance refractive result (i.e. no glasses for far vision).   Superior pre-surgery lens measurements and calculations are coupled with additional in-surgery procedures and post-surgery laser (LASIK if required and suitable) to deliver visual acuity excellence.  Low pre-existing astigmatism is corrected by this surgery. 

Enhanced Cataract/Refractive Surgery for Astigmatism  Hospital or private facility based procedure for higher degrees of pre-existing astigmatism.   There is great emphasis on achieving the best distance refractive result (i.e. no glasses for far vision).   Superior pre-surgery lens measurements and calculations predict the best special (toric) implant lens.

Enhanced+ Cataract/Refractive Surgery with a multifocal lens  Same as Enhanced Surgery above but the multifocal implant corrects both distance AND near vision and eliminates the need for reading glasses for most normal daily functions.

Enhanced Cataract/Refractive Surgery Procedure utilizing laser (for any above enhanced surgeries)  Instead of a blade and ultrasound...  laser technology is used for both making incisions and to remove your clouded natural lens.  Utilizing laser technology is thought to causes less trauma/inflammation to the delicate tissues of the eye and may be safer for some patients, shortens healing times and delivers a more precise end result.  Discuss details and current results with your surgeon.    Not generally available in hospital environments.