Laser Cataract Surgery on “A Current Affair”

After last night’s “A Current Affair” story about laser cataract surgery I expect to be fielding a lot of questions next week. 

The program, which was heavily promoted using a “sixty second surgery” sound bite,  reported the use of Alcon’s LenSx femtosecond laser for cataract surgery in Sydney. 

The ACA website promo says:

Cataract eye surgery is one of the most successful procedures in medicine, but imagine if the same procedure took a painless 60 seconds. A revolutionary new machine has just arrived in Australia to restore vision, which offers a non-invasive procedure and remarkable results with no pain.

Well, you need to keep using your imagination.

The story was misleading for a number of reasons. There has been no change in pain control, which remains excellent, and cataract surgery does not now take 60 seconds. In fact, using the new laser actually  takes longer because patients having femto cataract surgery are essentially having two procedures. First, they have the laser procedure in the laser room, which replaces the initial difficult but relatively brief part of the current standard operation. Then, because the laser doesn’t actually remove the cataract, they are moved to the operating theatre, where the cataract is removed and the lens implant inserted.  This second part remains essentially unchanged. The surgeon that was featured used a machine that has been around for 7 years to remove the cataract, and as you could see it still works very well.  

Does the new laser make the procedure safer, as the ACA surgeon said? Well, it might. And that’s as far as you can go at present. There is simply no evidence yet that femto surgery is safer.  There have been about a thousand cataract operations using the femtosecond laser worldwide, and as the infection rate using the current standard technique is less than 1/1000 we are nowhere near seeing the numbers required to compare one technique to another.  The marketers tell us that the wounds created are more precise than those made with a knife, and that this will lead to reduced wound leakage. Since wound leakage is a risk factor for infection, they suggest that the infection risk will be lower. Is there any evidence to support this? Not yet. It is speculation.

As I said in my previous blog the new technology is certainly very exciting.  So far it looks like the main benefit will be more accurate lens position, and this may mean less patients needing distance glasses after surgery. It may have the power to make a wonderful, miraculous operation even better. But we need to be very careful of crafty spin.

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