Eyeworld

FEB 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/78719

Contents of this Issue

Navigation

Page 78 of 111

February 2011 January 2012 EW REFRACTIVE SURGERY 79 ting too much of an effect. Clearly, the arcuate incisions are working." Dr. Solomon believes that there are enough femtosecond lasers for cataract surgery used around the globe that ophthalmologists should start seeing more data at the ASCRS•ASOA Symposium & Con- gress this spring and the American Academy of Ophthalmology meet- ing this fall. "Whether they'll be comparing LRIs for the treatment of astigmatism (pictured here) can have variable results, causing some surgeons to use the femtosecond laser to make arcuate incisions Source: Louis D. Nichamin, M.D. Another advantage of using the femtosecond laser is the ability to create intrastromal ablations, which can't be performed with a manual LRI. "We can make intrastromal ab- lations to treat low-level cylinder, where we don't break through to the surface," Dr. Donnenfeld said. "We can treat astigmatism in a repro- ducible way without cutting through the superior corneal nerve, without creating an epithelial defect, and without the discomfort of an in- cisional surgery." Furthermore, there is no learn- ing curve for the novice surgeon. The incision Dr. Donnenfeld or Dr. Solomon makes is the incision any surgeon in the world will make, regardless of experience. Femtosecond cost and lack of data Obviously, the femtosecond laser is not free and can cost upward of half a million dollars. This, said Dr. Donnenfeld, is the biggest disadvan- tage. "Any time we have a disruptive new technology that completely im- proves upon what we're doing, there's a cost associated with it," he said. "There's going to be some neg- atives with that side of the equation. But to me, the inherent accuracy and precision of the laser offsets any cost concerns." "When the femtosecond first came out for LASIK, people said it added too much expense for very lit- tle reward or gain," Dr. Solomon said. "I don't think that is going to be an issue. In fact, if you look at market share, femtosecond lasers have the market share of LASIK. I think the cost has worked itself out. I think patients are interested in re- fractive outcomes. If the femtosec- ond lasers provide better refractive outcomes for cataract surgery, then the market share will grow. Of course, that has yet to be deter- mined." Data directly comparing refrac- tive outcomes of manual LRIs and femtosecond-made arcuate incisions is not yet available, but studies are in the works. There is data on fem- tosecond incisions, however. "We presented the first study of laser femtosecond cataract surgery looking at the cylinder," Dr. Donnenfeld said. "There was a 70% reduction in astigmatism in patients treated with the femtosecond laser using the Eric Donnenfeld nomo- gram with a 33% reduction. This compares very favorably to anything in the literature." "If we're wondering about the variability of LRIs, if part of it has to do with not achieving a consistent arc and consistent shape and depth, the femtosecond laser takes all that out of it," Dr. Solomon said. "Whether that will translate into more consistent outcomes with the management of astigmatism has yet to be seen. One thing we do know is we're having to back way off of a standard LRI nomogram with [fem- tosecond] arcuates. I'm taking the Donnenfeld nomogram and reduc- ing it by a third because we're get- the two or even more importantly just showing good, consistent results with astigmatism is going to be a huge advance in the treatment of astigmatism at the time of cataract surgery," he said. "I think the concept that the femtosecond laser provides a more efficient, customizable, and ad- justable way to do an astigmatic keratotomy is exciting," Dr. Donnenfeld said. "This will remove the inconsistencies of the astigmatic procedure. It will also bring many ophthalmologists who aren't doing LRIs now into this, which will offer them the ability to participate in presbyopic IOL surgery." EW Editors' note: Drs. Donnenfeld and Solomon have financial interests with AMO and Alcon (Fort Worth, Texas). Contact information Donnenfeld: eddoph@aol.com Solomon: kerry.solomon@carolinaeyecare.com Save the Date! Saturday, April 21, 2012 7:00 – 9:30 AM McCormick Place 2012 ASCRS•ASOA Symposium & Congress www.eyeworld.org

Articles in this issue

Links on this page

Archives of this issue

view archives of Eyeworld - FEB 2012