EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/176967
Limitations, timeline There are limitations to the possibilities of the femtosecond laser in other subspecialties, however, Dr. Lindstrom said. He said that he is not optimistic that the additional uses of the femtosecond laser will greatly affect or change treatments across subspecialties. "The tissue treated with the femtosecond laser needs to be avascular and transparent. This limits us to the cornea, aqueous, lens, and vitreous. Sclera can be made transparent with hyperosmotics, so scleral cutting would be possible, but glau- D CTE ETRA 2 Donnenfeld: ericdonnenfeld@gmail.com Lindstrom: rllindstrom@mneye.com Soria: soriafelipe.md@gmail.com IO NS XTE &ULL % N 4 s 4HE 0ERFECT ,2) !+ +NIFE &OR %ITHER 3UPINE /R 5PRIGHT 0ATIENTS s 3HORTER (ANDLE !LLOWS )NCISION #REATION !T 4HE 3LIT ,AMP s !LSO )DEAL &OR 5SE 5NDER !N /PERATING -ICROSCOPE s 5NIQUE $OUBLE &OOTPLATE )NSURES !CCURATE 0RECISE $EPTH 3ETTINGS 2ESULTS s 3TEP MM 7IDE "LADE %XTENSIONS OF -ICRONS 0LUS &ULL %X T E N S IO N 2 E T RAC T I ON s 4ITANIUM (ANDLE -ADE )N 4HE 53! !ND !VAILABLE &OR ! 3URGICAL %VALUATION 7ITHOUT /BLIGATION #ALL &OR -ORE )NFORMATION /R 'O 4O /UR 7EBSITE Editors' note: Dr. Soria has no financial interests related to this article. Drs. Donnenfeld and Lindstrom have financial interests with Alcon (Fort Worth, Texas), Bausch + Lomb, and Abbott Medical Optics (Santa Ana, Calif.). Contact information P 4O VI EW Femtosecond lasers could have uses in the posterior segment as well as the present uses in the anterior space. For glaucoma surgery, the femtosecond laser could potentially create openings in the trabecular meshwork. "The possibilities exist for femtosecond laser trabeculectomies that will provide better openings and conduits for aqueous drainage subconjunctivally, and this can be accomplished without the need for cutting through the surface of the eye," Dr. Donnenfeld said. For retina surgery, femtosecond lasers could be helpful in treating vitreous traction, and with low energy and no thermal damage, they could be helpful in removing vitreous traction in the macula, he said. He said the treatments have the potential to provide more precision and reproducibility than conventional manual surgery, which could expand retina treatments to outside the retina subspecialty. The femtosecond laser does have a learning curve, but refractive and cataract procedures performed with the laser have shown that it is a short curve with highly reproducible results, Dr. Donnenfeld said. "I believe [femtosecond lasers] will broaden the use of these procedures so that non-specialty trained ophthalmologists will be able to perform these surgeries with equal dexterity as subspecialty trained surgeons because of the reproducibility of the procedure," he said. OP Posterior possibilities coma [treatment] is transitioning to stents. I doubt the femtosecond would help vitreoretinal surgeons who now do small gauge vitrectomy with self-sealing incisions," he said. He emphasized that new indications are currently in development and not yet ready for use. Dr. Soria said that additional factors and study will be needed for new femtosecond indications, but the new options could be available in a few years. "It is difficult to determine the time [that we will see these], probably one or two years," he said. "The technology is available. We now need new probes for vitreoretinal surgery and a different application approach for glaucoma surgery." Overall, Dr. Soria predicts that femtosecond laser technology will expand into other indications with added benefit to patients, as he has seen in his work with the laser in cornea. "The femtosecond technology will continue to improve, and hopefully we could have one machine that can do different procedures in the different subspecialties," he said. Dr. Donnenfeld also said that femtosecond technology could present new uses into the future. "Femtosecond laser is an extraordinary technology whose applications are almost limitless in the field of ophthalmology, and all we need is a good imagination to find new uses, which will expand the scope of this laser and improve patient care," he said. "These procedures, I believe, will begin soon; we've already dramatically expanded the use of femtosecond lasers today, and the indications will go beyond what is available now as new ideas become possible with this advanced technology." EW VI EW the posterior capsule to maintain centration for optimal accommodating lens function," he said. The Steinert* Mini LRI & AK Diamond Knife #OME 3EE 5S AT !!/ "OOTH .O 3360 Scherer Drive, Suite B, St. Petersburg, FL 33716 s 4EL s &AX %MAIL )NFO 2HEIN-EDICALCOM s 7EBSITE WWW2HEIN-EDICALCOM $EVELOPED )N #OORDINATION 7ITH 2OGER & 3TEINERT -$ 1334 Rev.A Mantegna, Dancing Muse BBBC