Laser Cataract Surgery vs. Traditional: Uses, Benefits, and Side Effects

With age-related cataracts, the normally clear lens of the eye, the part that focuses light rays on the retina, gradually becomes cloudy over time. This must then be removed and replaced with an intraocular lens (IOL).

While the procedure typically is done with standard, or traditional, cataract surgery, for some cases, what's known as laser-assisted cataract surgery can offer greater precision and may be deemed important. While both of these treatments aim to free you of cataracts, the way they accomplish this involves some pivotal differences.

This article will discuss how both procedures work, what the key differences between them are, and when it's important to undergo laser cataract surgery versus the traditional approach.

Cataract surgery preparation

Luis Alvarez / Getty Images

What to Know About Laser Cataract Surgery

With this type of cataract surgery, a laser makes fine cuts in the clear dome of tissue at the front of the eye called the cornea to enable the ophthalmologist (eye surgeon) to access the cloudy lens and remove it.

Traditionally, these cuts are made by hand by the ophthalmologist. But with the laser-assisted approach, the cuts are made by a laser.

What Is a Laser?

Laser stands for light amplification by stimulated emission of radiation. A device produces light at a specific wavelength and amplifies it. The light beam produced is coherent, meaning the peaks and valleys of the light waves are lined up. It is emitted in a narrow beam.

How Does It Work?

When you undergo laser-assisted cataract surgery, the surface of your eye is first mapped by the laser system. These systems are able to precisely map the structures of eye and allow the surgeon to direct the laser accurately.

The laser system creates a precise 3-D image of the structures of the eye. Then, in a matter of seconds, the laser makes the incisions exactly where they need to be.

The laser is used to assist in the rest of the cataract procedure as well. For instance, in addition to creating precise incisions, the laser can soften the cataract. Softening is particularly important if the cataract is a hard one and the ultrasound probe that is traditionally used to break them up is not enough.

Laser-assisted cataract surgery is designed for:

  • Those with hard cataracts
  • Those with astigmatism (irregularly shaped cornea)
  • Those who are planning to have their natural lenses replaced with premium IOLs that can correct for more than just distance vision
  • Those surgeries in which incisions would be difficult to create

This is particularly effective in cases where the hope is to improve vision more than normally would be possible. Laser-assisted cataract surgery can:

  • Offer better vision early on, since by applying the laser first, less ultrasound energy is needed, leading to reduced corneal swelling
  • Reshape the cornea to more precisely correct mild astigmatism

Laser-Assisted Cataract Surgery Delivery

Here's what to expect if you select laser-assisted cataract surgery. At the start of the procedure, your eye will be dilated. In this procedure, drops are given that cause the pupil, which is the black circle at the center, to widen. You'll also be given some medicine to help you relax.

Drops will then be put in your eye to numb the surface. You will be awake for the procedure, which will take around 15 to 20 minutes. While the procedure is ongoing, you will feel some pressure and may see a mix of colors.

Once the cataract is removed and the new, usually premium lens is inserted, the procedure is complete. A protective shield will be placed over your eye. You'll be monitored for about half an hour and then allowed to leave. Your vision may still be blurry for the next couple of days as your eye heals.

Side Effects

In most cases the laser-assisted surgery will go as planned. But, there still may be some side effects to contend with. Here's what you could expect:

  • Redness
  • Swelling
  • Infection
  • Bleeding
  • Blurry or hazy vision caused by scar tissue

Prices and Where to Get It

Laser-assisted cataract surgery with a premium intraolcular lens for those without insurance can cost around $4,000 to $6,000 per eye. In most cases, insurance will not cover laser-assisted cataract surgery.

The laser-assisted cataract procedure can be done in a hospital operating room or at a surgical center equipped with the needed machinery.

What to Know About Traditional Cataract Surgery

In most industrialized countries, traditional cataract surgery is the most commonly performed surgical procedure.

How Does It Work?

With traditional cataract surgery, the ophthalmologist will measure your eye prior to the procedure to determine the needed power of the intraocular lens you'll need to see clearly.

The surgeon will remove your cloudy natural lens and replace it with a clear artificial one. The process of breaking up the cataract is called phacoemulsification.

They begin by creating small incisions in the eye to maneuver an instrument that breaks apart a cataract with the aid of sound waves. This same instrument suctions away the small pieces of the lens. The preselected intraocular lens can then be inserted into the eye in its place.

Such traditional cataract surgery can benefit anyone with a cloudy natural lens. It is considered extremely safe and effective.

Traditional Cataract Surgery Delivery

Before undergoing this procedure, you will be asked to take drops for a few days to help minimize the risk of developing swelling or infection.

On the day of surgery, you can expect the following:

  • To be asked to refrain from eating solid food prior to surgery
  • To have the surface of your eyes numbed
  • To be given something to help you to relax

During the procedure, you will be aware of what's going on, and you may see movement or light, but you will not be able to tell what the ophthalmologist is doing. The ophthalmologist will use a small, pen-sized instrument to break apart the cataract and remove it. An artificial lens will then be inserted through these same incisions.

After the surgery, you will be expected to remain for about 30 minutes before someone can drive you home.

Side Effects

While traditional cataract surgery is widely performed and usually goes smoothly, there can be some risks. These can include:

  • Swelling inside the eye or at the front
  • Bleeding
  • Infection
  • Retinal swelling
  • Retinal detachment
  • Blurred vision
  • Glare, dark shadows, and circles around lights at night
  • Vision loss
  • Lens shifting in the eye

Prices and Where to Get It

Traditional cataract surgery with a standard lens costs between $3,000 and $5,000 per eye out of pocket. However, if you get premium lenses to correct astigmatism or to correct vision at different distances, the cost will increase.

You can undergo traditional cataract surgery at either an outpatient center or a hospital.

Which Treatment Is Best for You?

Not everybody is eligible to receive laser-assisted cataract surgery. Determining whether you can undergo the laser-assisted approach depends on:

  • Whether you have any astigmatism you need corrected during the cataract surgery, which can be done with the laser-assisted approach
  • Whether you're slated to get a premium multifocal lens, to correct for near and intermediate vision as well as traditional distance, or a toric lens to correct astigmatism

Those who have particularly hard cataracts may also benefit from the laser-assisted approach since the laser can be used to soften the cataract before using the ultrasound probe to break it apart.

If you do qualify for the laser-assisted approach, it's important to ask yourself what you hope to accomplish. You may opt for traditional cataract surgery if:

  • You simply want to get rid of the cataract, and the idea of continuing to wear glasses or contacts is not a real deal-breaker. (Note that there is no guarantee you won't need glasses even if you choose the laser-assisted procedure.)
  • You want to keep the cost of the surgery to a minimum.

Can Both Surgeries Be Used Together?

It is possible to use a laser to aid in a manual cataract procedure at times. So, if an ophthalmologist makes a manual incision that is perhaps too small, it is possible to enlarge this with the aid of the laser without any complications.

This can be used to help avoid capsule shrinkage that can result and lead to the lens becoming decentered down the line. In short, it can keep the procedure complication-free.

Coping With Side Effects

If you find yourself contending with side effects after either laser-assisted cataract surgery or traditional removal, it's important to immediately alert your ophthalmologist. While cataract surgery complications can be successfully treated with medication or surgery, they can sometimes threaten vision if not promptly dealt with.

Summary

With both laser-assisted cataract surgery and traditional treatment, the aim is to remove the cloudy lens in the eye and replace it with a clear intraocular lens. The laser approach can precisely create the needed incisions for the surgery and can also soften up the cataract itself so that it is easier to remove.

But, this approach is only available for those intending to have their astigmatism corrected or to receive premium IOLs that will help them to be free of glasses. Conventional cataract surgery is an extremely common and effective procedure that tends to be less costly than the laser-assisted approach.

A Word From Verywell

It's great to have options for cataract removal. Either procedure can successfully treat your cloudy lens and allow you to resume your activities with potentially even better vision than before. Talk to an ophthalmologist about the right option for you.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Wu BM, Williams GP, Tan A, Mehta JS. A comparison of different operating systems for femtosecond lasers in cataract surgery. J Ophthalmol. 2015;2015:616478. doi:10.1155/2015/616478

  2. Duke University. Understanding the benefits of laser cataract surgery.

  3. University of Michigan Kellogg Eye Center. Laser cataract surgery FAQs.

  4. Dick HB, Schultz T. A review of laser-assisted versus traditional phacoemulsification cataract surgery. Ophthalmol Ther. 2017;6(1):7-18. doi:10.1007/s40123-017-0080-z

  5. University of Central Florida. How much does cataract surgery cost?

  6. American Academy of Ophthalmology. Traditional cataract surgery vs. laser-assisted cataract surgery.

  7. American Academy of Ophthalmology. Cataract surgery, risks, recovery costs.