Laser or Traditional

[britsheldon25]

I have a dense cataract in one eye and I was told that laser-assisted surgery may be better to help "break" it down instead of traditional. I've seen mixed research between the two; however, are there any shown benefits of laser over traditional cataract surgery? As in is it worth to pay out of pocket for it?

[SoCalEyeSurgeon]

Agree with the short answer. I’ve previously posted a long answer here: http://david-richardson-md.com/cataracts/laser-cataract-surgery-why-you-dont-want-it/

[JohnHaganMD]

I read the longer answer and find it informative. My wife just had cataract surgery.  Our practice has several extra charge services:  femtosecond laser, ORA technology, multifocal IOLs, cornea refractive surgery and toric IOLs.  We chose plain vanilla spherical IOL with standard no-stitch phacoemulsification removal. She did marvelous and as a practicing ophthalmologist I think her choices were sound for her wishes and expectations about the surgery. The important thing were the skill and integrity of her surgeon, my friend and colleague, who is a highly experienced and skillful surgeon, warm and compassionate.

[britsheldon25]

That is good news, I am glad your wife is doing well. It seems like several surgeons try to upsell the premiums IOLs and if not they try to make money out of standard monofocals by suggesting laser-assisted surgery, which is why I was asking if it was worth it. I am glad to know that it isn't. I have double vision and astigmatism so they were saying doing it with laser would be more precise as well as help break down the cataract easier. Is there an importance in the shape of the IOLs as you mentioned "vanilla spherical"?

[dori76]

I think he meant to say aspheric IOL, not spherical IOL. I was under the impression that most standard monofocal IOLs used today are aspheric.

[NightHawkGuy]

I had cataract surgery on my right eye a month ago and went with standard since laser-assisted was at least $1500 extra cost and I viewed some youtube videos of the surgery with and without and didn't see any advantage worth that extra cost unless perhaps you were getting LRI cuts on the cornea to reduce a little astigmatism since that might be more precise with the laser.  However I had rather high astigmatism 3D cylinder or so, and went with a monofocal toric IOL and no LRI.  Also I have read the astigmatism reducing LRI incisions effect can often become less effective a year or two after.

I don't think I would have gotten a better result with laser-assisted, at least not worth its cost.  It was a higher out of pocket cost than for the premium toric lens which was $1333 out of pocket.  With insurance, the basic surgery and basic lens costs ended up only around $350 for my part of the cost in comparison.

[NightHawkGuy]

Its important to get several eye surgeon consultations and you may see different options and opinions between them regarding laser-assisted, premium IOLs, etc.   I got 3 consultations and the cost estimates between them was signficant.  One place highly rated would have cost nearly double since they only have a premium package that costs almost $3000 that includes laser-assisted and any LASIK touchups after the cataract surgery.  But I didn't want extra cornea surgery beyond the cataract surgery, so to me that extra cost wasn't worth it.  The other 2 surgeons, one offered laser-assisted as an option but didn't push it and the other only did standard, so their prices were more similar and more reasonable.

[JohnHaganMD]

I did mean to say "mono-focal" all quality monofocal IOLs are aspherical now.  You should read this article:  http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You      ; Some offices use "soft sell" but many do hard sells to upgrade to all the extras, currently femtosecond laser, ORA technology, toric IOL, multifocal IOL,  corneal surgery to reduce astigmatism.  Often this is drilled into all the staff and the pressure to upgrade starts the moment you check in.

[JohnHaganMD]

The short answer is that studies to date have not documented that paying extra for the femtosecond laser makes the procedures safer.