"Laser pretreatment to soften cataracts https appears to be making cataract surgery safer two new studies suggest. There certainly seems to be a benefit to using the laser says American Academy of Ophthalmology AAO spokesman James Salz MD clinical professor of ophthalmology at the University of Southern California in Los Angeles. He reviewed the findings for WebMD. If you have a technique to soften the cataract there appears to be less chance of damage to the eye https Salz says. The research was presented here at the AAO annual meeting. Standard vs. Laser Cataract Surgery More than . million cataract surgeries are performed annually in the U.S. One in three mostly older Americans will have the surgery at some point in their lives. The surgery is performed to remove the natural lens of the eye https after it has become clouded over time. A permanent artificial lens is then implanted to replace the natural lens and provide appropriate vision https correction for each patient. Currently most aspects of cataract surgery including the initial incision and the breakup and removal of the clouded lens from the lens capsule are performed manually by the surgeon. An ultrasound https instrument with a vibrating needle is used to break up the cataracts https and a vacuum sucks them out. The new studies looked at using the socalled femtosecond laser to deliver nearinfrared light to fragment the cataract into tiny segments prior to removal. The idea is that all the surgeon will have to do is remove the pieces with a vacuum says researcher Mark Packer MD of Oregon Health and Sciences University in Portland. Ideally you wont need ultrasound or at least youll need less ultrasound.  Thats important because ultrasound can cause collateral damage to the eye https he says. It can hinder recovery and cause clouding of the cornea https which is the clear outer layer of the eye.  Although approved by the FDA the femtosecond laser procedure is not widely used in the U.S. according to the American Academy of Ophthalmology. Laser Cataract Surgery Requires Less Energy One new study led by William Culbertson MD of the Bascom Palmer Eye Institute at the University of Miami involved  patients. All had the femtosecond laser procedure in one eye and standard manual cataract surgery in the other. Lens fragmentation involved using the laser to make the incision and split the lens into sections and soften it by etching crosshatch patterns on its surface prior to use of ultrasound and removal. The lasertreated eyes required  less ultrasound energy to achieve cataract removal than the conventionally treated eyes. Also surgeons made  fewer movements in eyes that received laser pretreatment compared to manual standard surgery. Intuitively if we use less energy and fewer movements inside the eye we will have fewer complications less inflammation and swelling of the eye and faster recovery of vision https Culbertson tells WebMD. Because such problems are relatively rare however we need thousands and thousands of patients to prove this he says. The laser pretreatment adds about five to seven minutes to the usual  to minute cataract surgery Culbertson says. The study involved the most common types of cataracts https those graded  . Culbertson says that these findings may not apply to higher grade harder cataracts. Laser Cataract Surgery Causes Less Cell Damage Packer and colleagues assessed laser cataract surgery in terms of loss of endothelial cells on the inside surface on the cornea as counted after the procedure.  Packer consults for LensAR which makes the laser used in the study. Endothelial cells are a barometer of the health of the eye Packer says. They preserve the corneas clarity and they dont regenerate he says. When laser lens fragmentation was used in  eyes there was no loss of endothelial cells the study showed. In contrast there was  to  cell loss in  eyes that received standard treatment. Laser Cataract Surgery Other Advantages Other research has shown other advantages to laser surgery as well Packer says. Incisions are always precisely the same. Thats hard when we use our hands to perform the surgery he says. Also the laser allows doctors to perform more precise standardized capsulotomies which is the opening and removal of part of the lens capsule to make room for the new lens. This reduces the chance that a lens will later become displaced. Laser Cataract Surgery Who Will Pay The big issue is who is going to pay Salz says. The laser costs about  on top of the  ultrasound probe. The government Medicare https wont pay unless we prove thats the only way to do the surgery and clearly thats not true since standard surgery works he says. Packer says he envisions surgical centers or hospitals that have surgeons doing lots of cases investing in the laser. These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the peer review process in which outside experts scrutinize the data prior to publication in a medical journal."