Eyeworld

16 | EYEWORLD | SEPTEMBER 2020 ASCRS NEWS demonstrated in the hands of residents, and even when present, do not translate to a mean- ingful or measurable clinical benefit. However, the lack of experience in FLACS relative to CPS among residents in this study represents a major caveat, as it precludes the possibility of an apples-to-apples comparison of the two techniques. In the absence of a clear efficacy benefit, an argument in favor of FLACS could hinge on improved safety, though this study was underpowered to detect a difference in safety outcomes and failed to demonstrate a difference in many surrogate safety outcomes (e.g., total intraoperative time). Ultimately, this paper adds to the body of work that continues to call into question the feasibility of widespread adoption of FLACS in routine cataract surgery in the increasingly cost-conscious environment of U.S. healthcare. surgical technique to which their eye(s) were randomized. In the full study cohort, there was no significant difference in satisfaction or level of intraoperative comfort between the groups. However, among patients whose eyes were ran- domized to opposite techniques, the statistically significant majority preferred FLACS. Since masking of surgical technique did not occur, this finding may have been due to patient bias. That is, patients who experienced both tech- niques may have perceived FLACS to be a more cutting edge, high value, and precise innovation, thus assigning the technique greater value. Fu- ture studies that seek to assess patient experi- ence may benefit from docking the laser for a sham procedure in the CPS group or devising an alternative means of masking. Overall, this study suggests that while FLACS has compelling theoretical benefits (phacoemulsification energy reduction, stan- dardization of difficult surgical steps, shorter operative time), these benefits are inconsistently continued from page 15 Outcomes of resident-performed laser-assisted vs. traditional phacoemulsification Brock Hansen, MD, Preston Blomquist, MD, Peter Ririe, MD, Severin Pouly, MD, Chan Nguyen MD, W. Matthew Petroll, PhD, and James McCulley, MD J Cataract Refract Surg. 2020;46(9):1282–1286. CPS. There was no significant difference in best corrected visual acuity (BCVA), either preoperatively or at the postop day 1, week 1, month 1, or month 3 visits (P= 0.469, 0.539, 0.701, 0.777, and 0.777, respectively). Cumulated dissipated energy and irrigation fluid usage were not different between FLACS and CPS (P-values 0.521 and 0.368), nor was there a difference in the reduction of endothelial cell counts after surgery (P=0.881). Wound creation (P=0.014), cortical cleanup (P=0.009), and IOL implantation (P=0.031) were faster in the CPS group. Survey results indicated that the overall patient experience was similar for FLACS and CPS. n Conclusion: This first prospective randomized trial evaluating resident-performed FLACS shows that, in resident hands, FLACS provides similar results to CPS with regard to visual acuity, endothelial cell loss, operative time n Purpose: To compare the effectiveness of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPS) by resident surgeons. n Setting: Parkland Memorial Health and Hospital System, Dallas, Texas. n Design: Prospective randomized study. n Methods: All surgeries to be performed by PGY- 3 and 4 residents from October 2015 through June 2017 were eligible for inclusion. Patients were required to complete a postop day 1, week 1, month 1, and month 3 visit. Specular microscopy was performed preoperatively and postoperatively. Surgeries were filmed and each step timed and compared. Surgeon and patient surveys were filled out postoperatively. n Results: Of the 135 eyes of 96 subjects enrolled in the study, 64 eyes received FLACS and 71 eyes received References 1. He L, et al. Femtosecond laser-as- sisted cataract surgery. Curr Opin Ophthalmol. 2011;22:43–52. 2. Abell RG, et al. Femtosecond laser-assisted cataract surgery compared with conventional cata- ract surgery. Clin Exp Ophthalmol. 2013;41:455–462. 3. Reddy KP, et al. Effectiveness and safety of femtosecond laser-assisted lens fragmentation and anterior cap- sulotomy versus the manual tech- nique in cataract surgery. J Cataract Refract Surg. 2013;39:1297–1306. 4. Abell RG, et al. Toward zero effec- tive phacoemulsification time using femtosecond laser pretreatment. Ophthalmology. 2013;120:942–948. 5. Fan W, et al. 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