Here at Reveal Eye Care & Surgery we offer laser cataract surgery, and I have personally performed a number of cases. There are a lot of different perspectives on this topic. I would like to present my feelings on the surgery with my view based on the available evidence, and my personal experience. First off, the technology of laser based cataract surgery is amazing. Similar to All-Laser LASIK, the laser docks on the surface of the eye called the cornea. It does a scan of the eye which basically puts a virtual real-time image of the front part of the eye including the cataract. The surgeon is able to use these parameters to make a custom procedure for each patient's eye. Most of the lasers allow the surgeon to create a near perfect circular opening to access the lens (the capsulorhexis), partially create the incisions into the eye, create astigmatism correction with what are called relaxing incisions, and to partially break-up the lens before the surgeon enters the eye at all. The technology continues to improve and this procedure can now be rapidly completed. The next step involves the surgeon opening the incisions and proceeding with the cataract surgery. The surgeon still needs to circulate fluid in the eye and use an ultrasound probe to break up the lens and remove it. Many surgeons prefer using a scalpel to make the incisions still because they can be made farther to the periphery of the eye. There still needs to be irrigation and aspiration to remove the softer part of the lens and this step is usually more difficult with the laser. The surgeon still needs to manually place the new plastic lens in the eye. The steps with the laser generally take more time than the manual way of performing the surgery and there is an extensive debate about whether or not it does these steps better. The best data regarding this surgery indicates that the laser makes a circular opening that is more circular than the manual creation, but this is more likely to tear during the laser based surgery which may cause complications. There is no strong evidence that the energy from the laser improves the overall visual outcome, but there is some evidence that it may slightly decrease the total energy expended. There is some evidence that there may be an overall increased risk of complications with laser based surgery. I personally feel that the laser makes some steps of the cataract surgery easier, and other steps harder. In that light, I will do the laser-based cataract surgery if a patient requests it (despite the extra cost to the patient because it is not covered by insurance), but I let patients know that I feel the manual method of cataract surgery is superior at this time for most cases. If you would like to make an appointment to consider cataract surgery with Dr. Justin Aaker in Georgetown, Austin or Central Texas, please call 512-686-1224.