July 31--For many, cataract surgery is a fact of aging the same as gray hair or
wrinkles. As the eye ages, often its usually clear lens grows cloudy.
By age 80, more than half of Americans either have a cataract or have had
surgery to remove one, according to the National Eye Institute.
Mary Savoie, 79, was one such average American. On April 4, she underwent
standard surgery at Stanford's Byers Eye Institute to remove a cataract from her
left eye. Two weeks later doctors removed the cataract from her right eye, this
time using a different procedure.
Savoie became Stanford's first patient to undergo femtosecond laser cataract
surgery, a relatively new technique that some doctors say represents a potential
paradigm shift in the field.
"The healing in the right eye was so much faster," said Savoie, a Palo Alto
resident. "It was unbelievable."
Femtosecond lasers, so-called because they deliver ultrafast pulses of light per
quadrillionths of a second (a femtosecond), have long been used in optic
surgeries to correct conditions such as nearsightedness, farsightedness and
astigmatism. The near-infrared pulse of the laser essentially vaporizes targeted
tissues, allowing for precise "cuts."
The lasers, though, were only approved for cataract surgery by the Food and Drug
Administration in 2010.
"I think that everyone was surprised it took so long for this to be invented,"
said Dr. Artis Montague, a director of cataract surgery services at Stanford.
"It's the best thing to come along in a long time. I would say there hasn't been
a substantial innovation in cataract surgery since phacoemulsification was
Phacoemulsification is the standard modern cataract surgery technique.
Introduced in 1967, it uses ultrasonic frequency to emulsify the eye's internal
lens, after a surgeon first makes a small incision in the cornea and then tears
a circular opening in the eye's lens capsule by hand. That lens then is removed
by suction and replaced with an intraocular lens implant. A far less common
method in developed countries is extracapsular surgery, in which the lens is
removed in one piece.
Cataract surgery is generally considered to be safe and effective, but it does
require a surgeon to make extremely precise cuts inside of someone's eye. A slip
of the hand could mean blindness. Lasers, so the thinking went, might be more
accurate and precise, as well as less invasive, than even the best surgeon's
There were a few hurdles. In procedures to correct issues such as
nearsightedness, a laser is used to reshape the cornea. Cataract surgery would
require a laser to cut tissues past the cornea, deep inside the eye. Doing so
would require precise guidance to ensure the laser didn't accidentally cut into
surrounding tissues. There would also have to be better control over the
intensity of the laser.
One of a handful
The Catalys laser system, developed by OptiMedica of Santa Cruz, is one of a
handful of femtosecond laser systems for cataract surgery that have been
introduced in recent years.
"Basically what it does is allow a noninvasive laser to do several of the most
demanding steps of cataract surgery that I would typically do by hand before,"
said Montague, who has now performed about 25 surgeries using the Catalys.
The Catalys system uses a laser to make the corneal incision and to cut a
circular opening in the lens capsule. It also creates a detailed,
three-dimensional map of the eye to help the laser stay on track.
"I've done thousands of these surgeries, so my circles are pretty good, but the
laser gets it perfect every time," Montague said.
She said the laser allows the procedure to be much more precise, resulting in a
perfectly centered lens implant and better vision acuity.
The laser is also used to break up the cataract into tiny pieces, which then
requires less ultrasound energy to emulsify and remove. Montague said this
allows patients like Savoie to heal much faster. The initial cut and breaking up
of the lens are done before the patient is even moved to an operating room.
Other femtosecond lasers developed for cataract surgery, such as LensAR and
LenSx, vary in exact methodology but also use the lasers in combination with
A successful option
Scientists have explored the use of various types of lasers in cataract surgery
since the 1970s, but systems using femtosecond lasers are seemingly the first to
gain significant traction. Even so, the procedures are controversial.
Critics say that the surgeries aren't worth the increased cost, since the
current procedures are largely safe and successful already. The Catalys cost
Stanford about $500,000, said Montague, compared with about $80,000 for a new
There are about 60 Catalys systems in use around the world, said Mark Forchette,
OptiMedica's president and CEO. About half are in the U.S. Three are in
California, including the one at Stanford.
Savoie, the Stanford patient, first developed cataracts in her 50s. They grew
progressively worse. Eventually she just couldn't see well, with or without
glasses. She stopped driving at night or taking long road trips. Reading became
After the surgery, she said, she only requires glasses when reading.
Both surgeries were a success, but the right eye seemed to heal before the left,
even though surgery on the right eye took place two weeks after the left.
In the right eye she experienced none of the swelling or grainy feeling she felt
after the first surgery. Her vision is also better in the right eye, though it's
difficult to tell whether that has anything to do with the surgery.
"After the surgery, one of the greatest things was to see how blue the sky was.
I didn't even know it was that way, I hadn't seen it in so many years," Savoie
said. "The downside was I didn't know I had so many wrinkles."
Kristen V. Brown is a San Francisco Chronicle staff writer.
(c)2013 the San Francisco Chronicle
Visit the San Francisco Chronicle at www.sfgate.com
Distributed by MCT Information Services