Eyeworld

70 | EYEWORLD | APRIL 2019 C by Liz Hillman EyeWorld Senior Staff Writer YES CONNECT ATARACT Contact information Caspar: jjcaspar@ucdavis.edu de la Cruz: jnapoli@hotmail.com Schallhorn: jschallhorn@gmail.com T he FDA approved the use of a femto- second laser for various procedures in cataract surgery in 2010. Nearly a decade later, how is femtosecond laser-assisted cataract surgery (FLACS) being adopted by the young eye surgeons (YES) crowd? With the results from the 2018 ASCRS Clinical Survey in mind, EyeWorld spoke with physicians involved in three different resi- dency programs about the FLACS exposure in the YES group and their views on getting FLACS experience. Jeffrey Caspar, MD When UC Davis acquired a femtosecond laser for cataract surgery 4 years ago, Dr. Caspar spent the According to the results of the 2018 ASCRS Clinical Survey, 81% of residents have not performed laser-assist- ed cataract surgery during their training. Being that this technology has been available to us for the better part of a decade, it is surprising that it is not more widely adopted in residency training programs. For this month's column we spoke with three attending physicians intimately involved with residency cataract training and got their thoughts on exposing residents to this technology. Whether or not sur- geons-in-training will ultimately embrace this technology in their future practice largely depends on the type of practice they join. However, I am a firm believer that residency is the perfect time to be exposed to a variety of new technol- ogies while there is an experienced surgeon next to you to help guide you. —Samuel Lee, MD, YES Connect Co-Editor FLACS adoption among young eye surgeons first 6 months getting acquainted with it himself, then started getting his residents involved. It's relatively easy, he said, to get residents on board, with the laser company providing online and wet lab training, followed by 10 free laser patient interfaces so the resident could perform the pro- cedure with no cost to the patient. "My philosophy has always been that we should teach our residents with the latest tech- nology, whatever it is at the time, and see where it goes because some of these technologies don't go anywhere and some of them do," Dr. Caspar said. Femto training at UC Davis starts in the third year of residency, Dr. Caspar said. Some challeng- es trainees have with FLACS include the docking component and modifications to intraocular tech- niques. Hydrodissection, for example, needs to be gentle because laser-created bubbles and pressure could rupture the posterior capsule. Cortex re- moval also requires a different technique. Overall, Dr. Caspar said he doesn't think most ophthalmology residency programs have a FLACS component, in part because they may not have access to the laser. In terms of FLACS confidence, he thinks that could take 30–50 cases, which he added is not practical within most resi- dency programs. Julie Schallhorn, MD All third-year residents at the UC San Francisco become certified in FLACS, Dr. Schallhorn said. "Adoption of femtosecond lasers in residen- cy training has been spotty," Dr. Schallhorn said, mentioning a 2017 survey that found only 44% continued on page 72 About the doctors Jeffrey Caspar, MD Professor University of California, Davis Jose de la Cruz, MD Assistant professor of ophthalmology University of Illinois Chicago Julie Schallhorn, MD Assistant professor of ophthalmology University of California, San Francisco In the 2018 ASCRS Clinical Survey, young physicians were asked, "Given the training and/or other experience you have received thus far, how would you rate your confidence with laser-assisted cataract surgery?" 1 to 3 years of training: 35% Very Confident or Confident, fellows: 38%, less than 5 years in practice: 60% 40 30 20 10 0 Very confident Confident Neutral Not confident Not confident at all Percent 1–3 years of training Fellow Less than 5 years in practice Samuel Lee, MD

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