Eyeworld

limited to a single site within a single training program and a small sample of resident surgeons, the findings may not be generalizable. The use of exclusion criteria based on predicted case complexity may also limit the application of these findings to a broader patient population, including those cases in which FLACS is theorized to benefit most. As described in the introduction of the paper, the authors cite research that suggests that FLACS may be of partic- ular benefit to patients with challenging problems such as shallow anterior chambers, subluxated lenses, and mature or posterior polar cataracts, 7,8 yet these patients were ex- cluded. Perhaps the most significant limitation is the drastic gap in experience of FLACS versus CPS among residents and supervising ophthalmologists. Prior to participation in the study, each resident had participated as the assistant or primary surgeon in an average of 201 CPS cases; the mean number of FLACS cases was 12. While specific data were not provided on the teaching surgeons' level of experience, it is highly likely that their experience was similarly lopsid- ed, given that CPS has been the predominant method of cataract extraction for decades and that FLACS is relatively newer and has not been as widely adopted. It is possible the relative lack of FLACS experience, as opposed to a factor intrinsic to the technique itself, is behind the absence of benefit in terms of efficiencies of time, energy, and irrigation fluid usage. The authors high- light an example scenario in which dearth of experience may be a driving factor: In FLACS cases, wound creation time was longer than in CPS cases due to difficulty with identification of the plane of laser incision. In addition, the surgical step of cortical removal in FLACS is made more difficult by the laser cuts into the anterior cortex, which render it difficult to engage the edge of the cor- tex. Skills such as these are likely to be experience-related and operator-dependent. In contrast to this paper, prior work demonstrated a significant decrease in phacoemul- sification energy use in FLACS compared to CPS in both experienced and resident surgeons. 4,9,10 However, there is a learning curve for FLACS even among experienced sur- geons; the lack of experience among residents in this study may account for the discrepancy with the findings of other work. 11,12,13 This may also be reflected by the residents' perceptions of each surgical technique, in which 72% of residents reported feeling comfortable with independently performing CPS, while only 39% felt similarly comfortable with FLACS. Subjects completed questionnaires to assess whether their experience of surgery differed depending on the continued on page 16 Look to Stephens for instrument sets. I N S T R U M E N T S | S I N G L E U S E | D R Y E Y E | B I O L O G I C S Stephens Instruments | 2500 Sandersville Rd | Lexington KY 40511 USA Toll Free ( USA ) 800.354.7848 | info@stephensinst.com | stephensinst.com © 2019 Stephens Instruments. All rights reserved. Stephens Instruments offers a wide selection of instrument sets for a variety of ophthalmic procedures. Backed by a limited lifetime warranty our instrument sets come with the superior service that Stephens is known for. Contact our sales team to discuss the specific needs of your practice. S5-1085 Barraquer Cilia Forceps S5-1690 Jewelers Forceps S8-1015 Castroviejo Lacrimal Dilator S2-1135 Golf Club Foreign Body Spud S2-1170 Alger Brush, Rust Ring Remover FOREIGN BODY SET

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