FLACS (Femtosecond laser assisted cataract surgery), has been the talk of the town for the past few years. In this technique, the Femtosecond laser is used to make the incisions, do the capsulorhexis (the circular tear in the anterior capsule of the lens) and break up the lens matter, which is then removed using a conventional phacoemulsification machine followed by lens implantation. The system is very good but has some drawbacks, mainly the cost (this is about double that of conventional phacoemulsification surgery done without the use of the femtosecond laser.
Second is logistics, as the whole operation becomes a two-step process with the femtosecond application being done on the laser machine and then the patient is moved to the conventional operating table where lens removal and IOL implantation are done, meaning that more time is spent per procedure than in a conventional phacoemulsification procedure.
Enter the nanosecond laser. Here the laser is linked to your normal phacoemulsification machine and helps in nucleus removal by reducing the total amount of energy delivered to the eye. It is a one-step procedure without the need to move patients from one platform to another during surgery. The cost of the machine is about 20-25% of the outlay involved in acquiring a femtosecond laser machine. The consumables used per case also cost about 10-15% of that used in FLACS.
This will still mean that there is some incremental cost above conventional phacoemulsification surgery, but that is more likely to be about 25%, compared to 100% for FLACS. If the technology proves itself, it will offer a more affordable way to offer ‘laser’ cataract surgery to our patients.
- Vryghem JC. Early experience with nanosecond laser cataract surgery. Presented at: 34th Congress of the European Society of Cataract and Refractive Surgeons; Sept. 10-14, 2016; Copenhagen, Denmark