Eyeworld

MARCH 2020 | EYEWORLD | 37 C "If we're going to teach residents how to do surgery, we need to teach them how to do things manually," Dr. Safran said. "They are never going to have another chance to learn how to properly handle tissue, to learn how to do a proper capsulorhexis. Young surgeons will have the opportunity after they finish residency to demo different lasers, but surgeons in train- ing have a unique opportunity to learn and gain experience in how to physically handle and ma- nipulate tissue on live patients with experienced instructors overseeing them. There are many things that a laser cannot do and situations for which the laser cannot be utilized, and these manual skills will be necessary for any surgeon to be successful at handling complex issues, whereas using a laser is not. Many top surgeons have either abandoned FLACS or never used it, but they all have in common excellent manual "With the decreasing reimbursement for cataract surgery, surgeons will continue to seek out upgrade options to support their practice. These upgrades are a service to our patients, as they provide additional benefits to surgery, while at the same time, they allow us to improve the financial pro- file for our practice," she said. What's more, Dr. Donaldson said femtosecond lasers have become more affordable for physicians with companies offering options to help offset an initial, large financial commitment. Steven Safran, MD, said he thinks FLACS is a "pretty worthless technology." "To me, the laser doesn't offer any ad- vantage over manual surgery," Dr. Safran said, explaining that he doesn't see refrac- tive, safety, or efficacy benefits to using the laser in cataract surgery. He also said it can add to surgical time. continued on page 38 References 1. Yen AJ, Ramanathan S. Advanced cataract learning experience in United States ophthalmology residency pro- grams. J Cataract Refract Surg. 2017;43:1350–1355. 2. Visco DM, et al. Femtosecond laser-assisted arcuate kera- totomy at the time of cataract surgery for the management of preexisting astigmatism. J Cataract Refract Surg. 2019;45:1762–1769. 3. Roberts HW, et al. Femtosec- ond laser-assisted cataract sur- gery: A review. Eur J Ophthalmol. 2019. Epub ahead of print. 4. Newton RH, Meek KM. Cir- cumcorneal annulus of collagen fibrils in the human limbus. Invest Ophthalmol Vis Sci. 1998;39:1125–34. Contact Donaldson: KDonaldson@med.miami.edu Safran: safran12@comcast.net Trattler: wtrattler@gmail.com During your training and/or experience thus far, how many laser assisted cataract surgeries (LACS) have you performed? (# of eyes) 0% 10% 20% 30% 40% 50% I have not observed or performed any cases I have observed cases, but not performed any cases myself 1 to 5 cases performed 6 to 10 cases performed 11 to 30 cases performed More than 30 cases performed 11.5% 6.6% 6.6% 7.1% 42.6% 25.7% Given your training and/or other experience you have received thus far, how would you rate your confidence with laser assisted cataract surgery? 0% 5% 10% 15% 20% 25% Not Confident at All Unconfident Neutral Confident Very Confident 18.2% 15.2% 22.7% 22.0% 22.0% Source: 2019 ASCRS Clinical Survey

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