EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
contact with the posterior capsule during cataract surgery. In the last section, "Complications Management: Refractive IOL," Roger F. Steinert, M.D., Irvine, Calif., presented a pearl on a toric IOL case with a tilted and decentered lens. Dr. Steinert used the "iHandy Level" app, a free smartphone application, in the case. "This one [lens] was glaringly out of position. Sometimes you look at these and say, 'Wow, is it or isn't it, and where is it?' And this is the way to solve it. How do you use it? The trick is, the slit lamp beam. You rotate your slit beam to whatever angle you want to measure, so in this case I lined it up with the toric IOL marks and then I put the slit beam on the edge of my iPhone, and it will read down to a tenth of a degree exactly what the patient's true position is," he said. Editors' note: Drs. Braga-Mele and Steinert have no financial interests related to this talk. Dr. Lane has financial interests with PRN. Femtosecond laser advancements and potentials for the future of cataract surgery Robert Cionni, M.D., Salt Lake City, discussed the value of the femtosecond laser in cataract surgery in a technology panel. He first questioned how many people had a femtosecond cataract laser and how many people would be interested in getting one or using one, stressing the value he has seen since starting to use the laser in his practice two years ago. "The rapid growth of this technology has been amazing despite the very expensive cost of it," Dr. Cionni said. He said he has used the LenSx laser (Alcon) in more than 2,000 cases and is thrilled with the results and the rapid development of the technology. "Although the laser has worked really well, one of the limitations we saw early on with the LenSx system was with the curved yet rigid [patient interface] we developed with docking," he said. He said this caused folds in the cornea, which resulted in a need for the laser to be turned up higher. However, he said there have been improvements, notably Alcon's LenSx SoftFit to help the eye conform more gently to the patient interface. With these improvements, Dr. Cionni said the laser energy can be turned down by two-thirds. Other advantages he mentioned were pristine capsulotomy edges, a free-floating capsulotomy, easier docking, lower IOP, more comfort for the patient, and a shorter procedure time. "You don't have to fear an incomplete capsulotomy, which could result in a weakened edge, with this device," Dr. Cionni said. He said with these advancements, he can be in and out of the room for the procedure in less than three minutes. In terms of future advancements, Dr. Cionni said there has been a lot of talk about phaco energy. "We're hearing a lot of noise about not needing phaco energy during the cataract surgery," he said. If your lens system can chop up the nucleus, you should be able to do it without phaco energy, but the question is whether it will actually be better for the patient, he said. Dr. Cionni has been able to do cases without phaco energy to demonstrate that it can be done, and he said down the road phaco energy could be eliminated almost completely when there are phaco systems that are more stable with higher vacuum. Editors' note: Dr. Cionni has financial interests with Alcon. Pearl: Tell patients there is no association between cataract surgery and macular degeneration progression Important pearls for cataract surgeons dealing with macular degeneration cases are to be aware of the fact that an important study found no association between cataract surgery and progression of macular degeneration and that two risk factors can assist in determining progression. Keith A. Warren, M.D., Overland Park, Kan., was the instructor of "Co-management of Patients with Retinal Disease," an optional educacontinued on page 148