Eyeworld

34 | EYEWORLD | SUMMER 2024 ATARACT C Relevant disclosures Donaldson: AbbVie, Alcon, Bausch + Lomb, BioTissue, Carl Zeiss Meditec, Dompe, Eyevance, Johnson & Johnson Vision, Kala, LENSAR, Lumenis, Omeros, Oyster Point, PRN, Quidel, Science-Based Health, Sun, Tarsus, Versea Rubenstein: Alcon Contact Donaldson: KDonaldson@med.miami.edu Rubenstein: Jonathan_Rubenstein@rush.edu endothelial cell loss with femtosecond laser-as- sisted cataract surgery," Dr. Rubenstein said. He said it's helpful with white cataracts, given its ability to create an instantaneous cap- sulorhexis, and also in cases of high myopes and high hyperopes. "The other time I like it is in the manage- ment of astigmatism. I primarily use toric IOLs in the management of astigmatism, however, when I have patients in whom I correct most of the astigmatism with a toric IOL but leave a small amount of residual astigmatism, I will perform a mini LRI with the femtosecond laser to touch it up. I utilize the laser for fine tuning the astigmatism correction," he said. Dr. Rubenstein also uses FLACS in premium, advanced-technology IOL cases. Dr. Donaldson said she uses FLACS for all of her premium IOL cases as well and in some cases of mature cataracts, Fuchs, or trauma/weak zonules. She also mentioned its use in small eyes and for astigmatic correction. "I think the laser allows me to put less en- ergy into the eye and allows me to manipulate the lens less during surgery," she said, adding later that some alternatives to femto include Zepto (Centricity Vision) for capsulotomies and miLOOP (Carl Zeiss Meditec), a nitinol filament for lens pre-fragmentation. These alternative technologies, Dr. Donaldson said, are an attempt to try to capitalize on some of the benefits of the femtosecond laser (the precise capsulotomy and the ability to pre-fragment the lens) without the cost commitment of a laser purchase. Dr. Rubenstein said that for those who are not using the femtosecond laser in cata- ract surgery due to efficiency/OR flow issues, technology that combines the femtosecond laser and phacoemulsification platforms for efficiency purposes will be on the market soon from some companies and in the pipeline for others. "If someone gets a machine that combines femtosecond and ultrasound technology, you're going to see a resurgence of interest for it," he thinks. Dr. Donaldson said she finds the femtosec- ond laser to be a "wonderful tool and luxury that can make our cataract surgery easier." Many patients, she added, find the use of a laser during their cataract surgery an appealing con- cept as they associate the laser with precision and advanced technology. "There is evidence showing that the laser can help reduce energy expenditure during cataract surgery. There is also evidence that shows the laser can create a more precise capsulotomy and more accurate LRIs relative to manual phacoemulsification," she said. "Some smaller studies have supported the benefits of the femtosecond laser in cataract surgery, however, there are many studies that show no difference in final refractive outcomes or safety. Each practice needs to weigh the cost/benefit ratio in their specific scenario, as in many cases this may not be a feasible expenditure unless marketing strategies are implemented to offset the cost." continued from page 33 Tal Raviv, MD, Cataract Editorial Board member, shared what he wishes he had: 1. I wish one of my cataract work-up diag- nostic devices took a high-resolution face photograph (like aesthetic practices do) that auto-integrated into my EHR so I can definitively show my postops that the cat- aract surgery didn't cause their wrinkles, puffiness under their eyes, or slight lid asymmetry. 2. I wish there was a validated personality questionnaire that could help me avoid certain IOLs in certain patients. And I wish I had given it to [a patient] who ended up –0.50 D in a monofocal and complains bitterly that they can't see anything in the distance. 3. I wish I could put VR-type goggles on a patient, and after 10 minutes of self-di- rected testing, it would tell me the vision, dominant eye (how dominant), and which IOLs the patient would do best with, after having shown a simulation with the IOLs including photic phenome- na. This wish may be coming true soon. I WISH I HAD ...

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