Nov. 17, 2010 -- An experimental image-guided laser technique could change the way cataract surgery is performed for decades to come.
In a newly published pilot study of a system developed at Stanford University, precision with the image-guided laser was 10 times better than that achieved with the current manual technique, researchers say.
“This can certainly be called revolutionary,” says Los Angeles eye surgeon James Salz, MD, who was not involved with the study. Salz spoke to WebMD about it as a representative of the American Academy of Ophthalmology.
“I would never have dreamed that cataract surgery could be done as quickly and accurately as it is done with guided laser. This is going to make a good operation even better.”
How Image-Guided Laser Surgery Works
More than 1.5 million cataract surgeries are performed in the U.S. each year. One in three mostly older Americans will have the surgery at some point in their lives.
The surgery is performed to remove the natural lens of the eye after it has become clouded over time. A permanent artificial lens is then implanted.
While the lens is removed, the elastic capsule that surrounds it is left intact to allow for the placement of the new artificial lens.
Currently most aspects of cataract surgery, including the initial incision and the breakup and removal of the clouded lens from the lens capsule, are performed manually by the surgeon.
With the new technique, this is all done with a special laser guided by 3-D imaging.
After applying suction to hold the eye in place, a 3-D image of the eye is taken to determine corneal thickness, the distance from the back of the cornea to the front of the lens, and the distance from the front of the lens to the back, Salz says.
This information is used to program the image-guided laser to achieve the precise cut specified by the surgeon.
While it is clear the laser technique improves surgical control and precision, it is not yet clear if its use will result in better patient outcomes for a surgery that already has a high success and low complication rate.
But results from early clinical trials have been very promising, Salz says.
In the new pilot study, which included 50 people, patients who got the laser surgery achieved better vision overall, compared to patients whose surgeries were performed manually. But the difference was not statistically significant due to the study’s small size.
The study appears in the journal Science Translational Medicine.
The laser device used in the study was developed by Stanford associate professor of ophthalmology Daniel Palanker, PhD and colleagues, who conducted a series of experiments on pig, rabbit, and, finally, human eyes.
One major advantage of the technique, Palanker tells WebMD, is that it requires far less surgical skill than is needed now.
“Manual cataract surgery is skill dependent,” he says. “Different surgeons have different success rates. This will make cataract surgery much less dependent of the surgeon’s expertise.”
The system is being developed by OptiMedica, which funded the study. Palanker and five other co-researchers have equity stakes in the company.
Optimedica President and CEO Mark J. Forchette tells WebMD the company hopes to market the device globally starting next year, pending FDA approval.
Two other companies -- LenSX Lasers Inc., now owned by Swiss company Alcon, and LensAR Lasers of Winter Park, Fla. -- are testing similar systems. Salz says the LenSX system has been fully approved by the FDA for cataract surgery and the LensAR system has been partially approved.
“It is a bit of a race, but I expect all three to be approved,” he says. “This won’t replace traditional surgery and it won’t be an option for all patients. But I believe it will be an option for most and it is definitely a game changer. Cataract surgery is already one of the most successful operations we do, but this will take it to another level.”