The Byers Eye Institute at Stanford Hospital & Clinics is the first academic medical center on the West Coast to offer laser-assisted cataract surgery, an approach that provides precision, control and safety unmatched by traditional cataract removal methods. Using the Catalys® laser developed at Optimedica, a medical technology company with its roots based at Stanford, ophthalmologists at the Byers Eye Institute can now apply laser technology to assist in the surgical treatment of cataracts.
"Creating a circular opening in the lens capsule is a critical step in cataract surgery," says Artis Montague, MD, director of cataract surgery services at Stanford and director of the operating rooms at the Byers Eye Institute. "Experienced surgeons are quite good at creating these circles. I've drawn thousands of them, and can create that circular opening very well, but compare me making that circle to a laser making that circle, and the laser is going to be perfect every time."
That perfection, guided by a three-dimensional scan of each patient's eye, is just the first step. Because the laser breaks up the cataract into a latticework of tiny pieces, the surgeon can remove the cloudy lens with far less ultrasound energy. The difference in impact and inflammation is substantial, compared to traditional surgery, so patients can heal faster and with less discomfort.
One such patient is 80-year-old Mary Savoie, whose experience is unique. She had her first cataract removed at the Byers Institute using the traditional approach this April, and the second with the help of a laser just two weeks later. A month after the traditional surgery on her left eye, Savoie still felt the grittiness that patients typically experience. In her right eye, done with the aid of the laser, she felt nothing at all except for the dramatic improvement in her vision.
Laser technology has been used for decades to reshape the cornea to correct nearsightedness, farsightedness and astigmatisms. The challenge of using it in cataract surgery is to control the laser's intensity to avoid collateral damage to surrounding tissue, the retina and other parts of the eye, yet still to deploy enough power to accomplish the precise incision required forcataract removal.
The laser device used in the surgery also provides a noninvasive-imaging technique to create a 3-D computerized map of the eye. That map forms the basis of an ideal pattern for the laser to follow. That pattern is then superimposed on the three-dimensional image of the patient's eye to confirm for the surgeon that the laser is on target. It also allows the surgeon to monitor the laser's incisions.
The relatively low amount of energy needed to remove the lens reduces the risk of complications and infection; it also minimizes damage to surrounding tissue, including the corneal epithelium.
"It feels so much safer," says Montague, who has now performed about twenty-five surgeries using the Catalys. "Time will tell, but I think it has the potential to change cataract surgery tremendously."
This technology is also ideally suited to treat patients with astigmatism, which can be partially managed at the time of surgery using either laser-assisted corneal incisions or through implantation of specially designed intraocular lenses. As placement of these toric intraocular lenses must be precise, the creation of a perfectly round surgical opening is critical for the best possible outcome.
By Grace Hammerstrom