Last month the first major review so far of outcomes from cataract surgery with the new femtosecond laser was published. It is an important paper, representing the experience of expert cataract and refractive surgeons adopting this new technology in an advanced Australian surgical facility. The first 200 surgical cases performed by 6 surgeons were reported.
What did they find? Well, contrary to initial presumptions made and claims propagated on behalf of the technology, the complication rate for surgery actually went up slightly. This shouldn’t really be a surprise. The adoption of any new surgical technology or technique is accompanied by a “learning curve” as surgeons adjust to a new way of doing things, sometimes with unexpected differences in the course and outcome of an operation. These surgeons rapidly adjusted, but cataract surgery with femtosecond laser was still not as “safe” (considered purely as a function of the complication rate) as standard phaco-emulsification surgery in their hands. It’s possible that in the hands of less experienced cataract surgeons the complication rate of femtosecond surgery may have compared more favourably.
However, we should remember that phaco-emulsification cataract surgery was accompanied by an even steeper learning curve in it’s early days. There may be changes to instruments, software and technique that alter the safety profile in the future, and there may be improvements in visual outcome that make a small increase in the overall rate of complications justifiable. But at the moment the evidence for this is lacking.
The authors of this study should be commended for submitting this paper. I look forward to further developments.
SJ Bali et al. Early experience with the femtosecond laser for cataract surgery. Ophthalmology. 2012 May;119(5):891-9.