EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
February 2011 March 2013 Cataract/IOLs, femtosecond cataract EW FEATURE 107 A new twist on femtosecond platforms by Maxine Lipner EyeWorld Senior Contributing Writer Diving into the debate on combined versus dedicated cataract units F emtosecond lasers have become an accepted part of the LASIK lexicon and now are making inroads into the cataract arena as well, according to Seba Leoni, vice president, global franchise head, cataract, Alcon, Fort Worth, Texas. "Approximately 80% of LASIK procedures in the U.S. are done with a femtosecond laser," he said. Likewise, femtosecond cataract surgery is now on the upswing. In addition to femtosecond units dedicated to cataract use, two out of four of these lasers, the Victus (Bausch + Lomb, Rochester, N.Y.) and the LenSx (Alcon), have regulatory approval to do both LASIK flaps and lens-related procedures using one system. The question is, can these combination units measure up to their cataractdedicated counterparts? Scoring the combination entry Calvin W. Roberts, M.D., chief medical officer, Bausch + Lomb, thinks combination femtosecond systems do have the capability to deliver in both the cataract and the corneal realms. However, he offers a caveat—"only if it is a great laser with a great patient interface," he said. To perform a good cataract procedure with a femtosecond laser, he pointed out, you have to be able to get exquisitely good focus on the anterior capsule and within the lens, without any distortions coming from the cornea. "Therefore, the way that you can ideally dock the laser to the cornea for a cataract procedure is to have a fluid interface between the laser and the cornea so LensAR Laser System LenSx Laser Source: Alcon Source: LensAR Victus System Source: Bausch + Lomb that there's no contact to the cornea that could create folds or other distortions," Dr. Roberts said. For femtosecond cataract surgery the Victus uses almost a 100% liquid-filled interface, he said. "[It doesn't] require high vacuum in order to hold it in place because it's not creating distortion," he said. By contrast, to cut a corneal flap, 100% applanation of the interface against the cornea with high suction is needed. "You need no fluid," Dr. Roberts said. "You want the laser right against the cornea because what you need is accuracy down to about 4 microns, and you don't get that if you don't have the laser right against the cornea." Accordingly, the Victus platform offers two settings in one patient interface—a low vacuum, liquid one for cataract procedures, and a high vacuum, sans liquid interface for corneal cutting. Currently in the U.S. the Victus is approved for cutting corneal flaps as well as cataract capsulotomy. In addition, one new application that the Victus just received 510 clearance for in February is the creation of penetrating arcuate incisions in the cornea, something that study results indicate can offer a higher degree of precision.1 Likewise, the LenSx system can do double duty. "The LenSx laser platform was conceived as an imageguided surgical workstation capable of both lens and corneal surgery," Mr. Leoni said. "Surgeons choosing this platform will be able to select either cataract or LASIK flap applications based on the needs of each patient." Once selected the procedure is programmed and executed as it OptiMedica Catalys Precision Laser AT A GLANCE • New combination femtosecond lasers are designed to perform cataract surgery as well as cut LASIK flaps and more. • Proponents claim that these lasers can help practitioners save space and cut costs. • Opponents, however, argue that with these systems, tradeoffs in logistics and quality must be made. would be with a single-purpose device, he explained. "Key aspects of the LenSx laser flap creation include enhanced imaging and the use of a curved patient interface," Mr. Leoni said. He is confident that this combination system can deliver an excellent corneal flap while becoming a cataract surgical tool. This can work as long as the original design requirements for the system anticipate both applications, as the LenSx platform does, he explained. He sees some clear advantages to taking the combination tack. "If LASIK and cataract surgery are to be performed in the same venue, a single device may be less expensive for both hardware and service, as well as space considerations," Mr. Leoni said. Dr. Roberts agreed. "To have two femtosecond lasers, one for refractive and one for cataract, is a lot more money than having a Victus," he said. "Second, in terms of space in a tight ambulatory surgery center, not needing two machines and havcontinued on page 108 Source: OptiMedica