Eyeworld

I TECHNOLOGY & INNOVATION N FOCUS 40 | EYEWORLD | MAY 2019 Contact information Donaldson: KDonaldson@med.miami.edu Garg: gargs@uci.edu Lee: bryan@bryanlee.pro Weinstock: rjweinstock@yahoo.com by Chiles Samaniego EyeWorld Contributing Writer "I t is amazing to reflect on how rapidly cataract surgery contin- ues to evolve," Kendall Donald- son, MD, told EyeWorld. "Sur- gery continues to become less traumatic as we reduce energy put into the eye, ultimately in- creasing safety for patients while increasing the rate of visual recovery. "In addition, refractive outcomes continue to improve thanks to advances in technology." As cataract surgery transitioned into a re- fractive outcome-driven procedure over the last decade, the field has seen what Robert Weinstock, MD, called "a storm of innovation and technological advances." EyeWorld corresponded with Dr. Donaldson and Dr. Weinstock, as well as Sumit (Sam) Garg, MD, and Bryan Lee, MD, to find out what technological advances they use in their respec- tive practices and how these technologies have improved their cataract surgery outcomes. Advancing today's technologies Some advances have improved on existing tech- nologies. Dr. Weinstock said that the LENSAR femtosecond cataract surgery laser (LENSAR) "has advanced tremendously with iris registra- tion software to eliminate cyclotorsion error. By using preoperative imaging systems such as the Pentacam [Oculus], the Nidek OPD [Nidek], or the Cassini Total Corneal Astigmatism [Cassini Technologies], infrared images can now be sent directly and wirelessly to the LENSAR laser for a quick iris registration process once the patient is docked under the laser." Dr. Weinstock uses this technology to improve astigmatic corrections by ensuring the correct axis for arcuate incisions and also customizing the capsulotomy's shape to include marks useful for orienting a toric IOL implant. "Other advances in this platform are auto- matic nuclear density grading software applica- tions to provide the most appropriate fragmen- tation pattern depending on the density of the nucleus, which is imaged by the Scheimpflug imaging system," he said. "We have the CATALYS femtosecond laser [Johnson & Johnson Vision]," Dr. Garg said. "FLACS [femtosecond laser-assisted cataract surgery] is particularly useful for dense cataract cases and for those with comorbidities such as Fuchs' dystrophy and pseudoexfoliation. Also, the astigmatic incisions are much more precise than what I can accomplish freehand." Dr. Lee offered a contrasting opinion on FLACS. "There is no good evidence that the femtosecond laser improves phacoemulsifica- tion refractive outcomes or safety," he said. For intumescent cataracts, he occasionally employs the Zepto capsulotomy system (Mynosys Cellu- lar Devices), a device consisting of a thin nitinol A storm of innovation How technology improves cataract surgery outcomes At a glance • The last decade has seen "a storm of innovation and technological advances" attending cataract surgery's transition into a refractive outcome-driven procedure. • Advances to existing technologies such as femtosecond laser platforms and phacoemulsification machines along with new technologies improve surgeons' ability to carry out each step of the cataract surgery procedure with a high degree of accuracy and precision while reducing risk. • Cataract and refractive surgeons alike look forward to and will benefit from technology that will allow them to modify sphere and cylinder postoperatively. Toric IOL placed perfectly on the refractive capsulotomy nub created by the LENSAR IntelliAxis-L system Dr. Weinstock performs heads-up 3D cataract surgery with the NGENUITY system. Source (all): Robert Weinstock, MD

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