Femtosecond laser: the future of cataract surgery?

Cataract surgery techniques have evolved from intracapsular cataract surgery to extracapsular cataract surgery (ECCE) to phacoemulsification, with a progressive decrease in the size of the surgical wound and increased safety and predictability of the surgical procedure. Cataract surgical techniques and intraocular lens (IOL) technologies continue to evolve to provide patients with the optimum postoperative visual outcomes. Various lasers, including the erbium:YAG laser, have been evaluated for use in cataract surgery in different formats. The femtosecond laser has been used in corneal surgery, primarily for the creation of corneal incisions for laser in situ keratomileusis and penetrating keratoplasty wounds. The advantage of a femtosecond laser is the ability to create precise incisions in ocular tissue with minimal collateral damage. Currently, there is broad interest in the use of femtosecond laser technology for the performance of cataract surgery. A JCRS-sponsored symposium at the recent American Society of Cataract and Refractive Surgery (ASCRS) annual symposium in San Diego looked at the use of the femtosecond laser in various aspects of cataract surgery; ie, creation of clear corneal incisions, correction of astigmatism, creation of the capsulotomy, softening the lens nucleus to allow more efficient aspiration of a cataractous lens, and the potential use of this laser for the treatment of the crystalline lens to restore accommodation. While the early results with femtosecond technology in cataract surgery are promising, several questions have to be answered. The efficacy and safety of this technology in the various parts of cataract surgery will have to be addressed. One problem with a new technology such as the femtosecond laser is the lack of peerreviewed studies of its use. The early results of using this technology have been presented at several meetings such as the ASCRS symposium and the European Society of Cataract and Refractive Surgeons congress. However, reports from these presentations are just beginning to find their way into the ophthalmic literature. One area in which the femtosecond laser may have an advantage over traditional cataract surgical techniques is the performance of the continuous curvilinear capsulorhexis (CCC). A well-centered properly sized CCC is important to ensure the adequate centration and positioning of an IOL. Effective lens positioning, as well as centration of an IOL is important in