Bladeless cataract surgery is made possible by using a Femtosecond laser – an exciting new technology originally FDA approved for use in refractive surgery. The FDA has now expanded the indications to include ‘cuts’ in the cornea, including vertical and lamellar cuts. The possibilities for use now include but are not limited to femtosecond keratoplasty, astigmatic keratoplasty, and Intacs for keratoconus.

Femtosecond laser differs from the traditional method of refractive surgery in a number of ways. This technology uses a near infrared light to create precise subsurface cuts. Traditionally in refractive surgery, ultraviolet light sources, such as the excimer laser, have been used for precise surface cuts on the cornea. These light sources were dependent on the tissue properties to absorb the light. Femtosecond laser, on the other hand, works independently of light tissue absorption so photodisruption of deeper tissues is possible and the patient’s anatomy, such as steepness, flatness or thickness of the cornea, will not interfere with the cuts. This leads to a more uniform treatment. In addition, femtosecond pulses are very short, subpicosecond duration, which allows lower energy levels and aids in precision. The lower energy also decreases collateral damage.

Traditional methods for cutting the LASIK flaps include the use of a microkeratome blade, an oscillating blade which creates a shear factor. In a patient with a weak epithelium, there is increased risk of a resulting epithelial defect. With the femtosecond laser creating the flap, there is no shear factor and the risk of an epithelial defect is less.

To reiterate, femtosecond laser allows extreme precision in surgery. In one study presented this year at the American Academy of Ophthalmology, femtosecond laser incisions achieved perfect diameter accuracy in 100% of cases, while only 10% of surgeons’ manual cuts were within 0.25 mm error.

With the FDA label extension, femtosecond laser technology is spreading, with its largest impact on the future of cataract surgery. This technology was a highlight at this year’s American Academy of Ophthalmology in San Francisco.

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