Eyeworld

36 | EYEWORLD | MARCH 2020 YES CONNECT ATARACT C with these various techniques by the time they complete their training," Dr. Donaldson said. "With premium cataract surgery becoming a more common option and rapidly advancing improvements in lens options, graduating sur- geons should be prepared to offer their patients the latest technology in cataract surgery." She also said learning the technology in residency and fellowship allows for greater supervision during a learning curve. William Trattler, MD, said he's a "huge ad- vocate" for FLACS, finding it especially useful for creating a centered capsulotomy, fragment- ing the lens, and making marks for alignment of toric IOLs. Dr. Trattler said he finds FLACS reduces inflammation by reducing phaco energy, and this results in less corneal edema. However, there are some differences in surgical technique with femto compared to standard phaco, and it is therefore helpful for residents and fellows to gain surgical experience with femto during their training. At his center, Dr. Trattler said patients who elect to have a presbyopia-correcting or toric IOL have the option for FLACS included. It's also available to patients who might want it for arcuate incisions. A recent study of 189 eyes by Denise Vis- co, MD, found that femtosecond arcuate incisions provided a predictable improve- ment in astigmatism, with 95.8% ending up with 0.5 D of astigmatism or less. 2 Dr. Donaldson also uses the laser on all of her patients who have opted for astigmatism and/or presbyopia correction at the time of cataract surgery. She also uses it as a tool for some challenging cases, such as white cataracts, dense cataracts, traumatic cataracts, loose zonules, Fuchs dystrophy, and very shallow anterior chambers. Many studies performed over the last decade have not found any significant clinical benefit of FLACS over conventional cataract surgery. 3 So, it begs the question: Is the femto- second laser on its way out of cataract surgery or here to stay? Dr. Donaldson thinks it will remain a tool for premium cataract surgeries. by Liz Hillman Editorial Co-Director Femtosecond laser-assisted cataract surgery and the young eye surgeon About the doctors Kendall Donaldson, MD Medical director Bascom Palmer Eye Institute Plantation, Florida Steven Safran, MD Lawrenceville, New Jersey William Trattler, MD Director of Cornea Center for Excellence in Eye Care Miami, Florida After the FDA approval of the use of the femtosecond laser in cataract surgery in 2010, surgeons began to debate if there is truly a contribution to surgical out- comes when it is used. Comparative papers considering refractive outcomes and rate of complications have found, overall, no significant differences when the femtosecond laser is used compared to manual cataract surgery. This is probably one of the reasons why residency training programs have not universally incorporated the use of the femtosecond laser for cataract surgery into their residents' surgical training. EyeWorld interviewed three surgeons to get their thoughts on the role of FLACS and the incorporation into residency training. —Claudia Perez-Straziota, MD YES Connect Co-Editor W hile the utility of femtosecond laser-assisted cataract surgery (FLACS) is a widely discussed topic among practicing ophthal- mologists, its trickle down into training and those who are early in their career is mixed. According to one study, 44.1% of ophthal- mology residency programs included FLACS as of 2017. 1 The 2019 ASCRS Clinical Survey found that among respondents who were in residency, fellowship, or their first 5 years of practice, nearly 26% had neither observed nor performed FLACS and nearly 43% had ob- served but not performed FLACS during their training. About 33% of respondents said they were confident or very confident with FLACS. More established practicing ophthalmologists reported using FLACS in an average of 17% of their cataract patients, and more than 95% of these later-career ophthalmologists think FLACS offers clinical benefits, according to the survey. Kendall Donaldson, MD, said she thinks resident ophthalmologists should have experience with FLACS and extra- capsular cataract surgery and traditional phacoemulsification. "All of these techniques may be consid- ered an appropriate option in certain cases, and resident surgeons should feel confident

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