EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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20 EW NEWS & OPINION September 2013 Femtosecond laser offers potential for additional indications by Erin L. Boyle EyeWorld Senior Staff Writer The laser could have uses across ophthalmic subspecialties T he femtosecond laser has expanded its reach beyond refractive surgery to cataract surgery, and could expand still, to cornea, retina, and possibly glaucoma cases, making some complicated subspecialty procedures potentially easier for general ophthalmologists to perform. "Currently, femtosecond lasers are used in making flaps in LASIK and in femtosecond cataract surgery; however, there are several indications that will probably be occurring over the next several years that extend their use in cataract and refractive surgery and go beyond that into other subspecialties as well," said Eric D. Donnenfeld, MD, clinical professor of ophthalmology, New York University Medical Center, New York. Richard L. Lindstrom, MD, adjunct professor emeritus, University of Minnesota, Minneapolis, said possible future indications for the femtosecond laser include treating presbyopia with radial lensotomy using the femtosecond laser and treating posterior capsule opacity. An example of the advancement that the femtosecond laser has given to corneal transplant in the last 100 years, the use of a machine to perform a corneal transplant (femtodissection of donor and receptor). Performing a corneal transplant (femtodissection of donor and receptor) Another possibility includes the treatment of select vitreous floaters, he said. The laser could expand indications in corneal refractive surgery as well, Dr. Lindstrom said. Felipe A. Soria, MD, Vissum Corp., Alicante, Spain, and Instituto de la Vision, Montemorelos, Mexico, has clinical experience with corneal indications. Nine months ago, he began work with Jorge Alió, MD, on new incision patterns and instruments to improve corneal surgery with the benefits that the femtosecond laser offers. He said the technology has many possibilities in new indications. "Imaging technology such as OCT is entering a new dimension in resolution not only for the anterior segment but for retina," he said. "Now, we are able to visualize all the References 6. Artal P, Benito A, Pérez G, Alcón E, De Casas I, Pujol J, Marín J. An objective scatter index based on double-pass retinal images of a point source to classify cataracts. PLoS ONE 2011; 6: e16823. 7. Vilaseca M, Romero MR, Arjona M, Luque SO, Ondategui JC, Salvador A, Güell JL. Artal P, Pujol J. Grading nuclear, cortical and posterior subcapsular cataracts using an objective scatter index measured with a double-pass system. Br J Ophthalmol 2012; 96:1204–1210. 8. Benito A, Pérez GM, Mirabet S, Vilaseca M, Pujol J, Marín JM, Artal P. Objective optical assessment of tear-film quality dynamics in normal and mildly symptomatic dry eyes. J Cataract Refract Surg. 2011; 37:1481–7. Why continued from page 19 in a central location so that it is easily accessible, and we try to use it early in the intake; we want these assessments to be one of the first tests that we do, before we start to perturb the ocular surface and before any surgical decisions are made. The unique diagnostic benefits of this instrument, combined with its compact design, ease of use, convolved images to enhance patient education, make this next-generation objective light scatter and retinal image quality measurement technology an essential tool for eyecare professionals. In my experience, the multitude of capabilities of objective light scatter and visual quality measurement as applied in so many areas of eyecare are key to a more accurate understanding of our patients' conditions and in the management of their care. EW 1. Díaz-Doutón F, Benito A, Pujol J, Arjona M, Güell JL, Artal P. Comparison of the retinal image quality with a Hartmann-Shack wavefront sensor and a double-pass instrument. Invest Ophthalmol Vis Sci. 2006; 47:1710–6. 2. Kamiya K, Umeda K, Kobashi H, Shimizu K, Kawamorita T, Uozato H. Effect of aging on optical quality and intraocular scattering using the double-pass instrument. Curr Eye Res. 2012; 37; 884–888. 3. Martínez-Roada JA, Vilaseca M, Oudategui JC, Giner A, Burgos FJ, Cardona G, Pujol J. Optical quality and intraocular scattering in a healthy young population. Clin Exp Optom 2011; 94: 2: 223–229. 4. Saad A, Saab M, Gatinel D. Repeatability of measurements with a double-pass system. J Cataract Refract Surg. 2010; 36:28–33. 5. Cabot F, Saad A, McAlinden C, Haddad NM, Grise-Dulac A, Gatinel D. Objective assessment of crystalline lens opacity level by measuring ocular light scattering with a double-pass system. Am J Ophthalmol. 2013;155:629–635. Editors' note: Dr. Pepose has financial interests with Visiometrics. Contact information Pepose: jpepose@peposevision.com Source (all): Felipe Soria, MD layers of the retina and choroid with extreme detail. Femtosecond lasers are developing [with the aid of] OCT technology." "Femtosecond laser technology itself is developing," Dr. Soria continued. "Numerical apertures 10 years ago gave us the chance to focus on the cornea, and five years ago, we descended to the lens. The developments to come will be in the fields of glaucoma and vitreoretinal surgery. Presbyopia correction by modifying the lens anatomy is also in study." Anterior possibilities The femtosecond laser has been an important development in ophthalmic technology since its inception in the early 2000s. Not only could it have possible new indications in other subspecialties, but it is also offering new possibilities within refractive surgery, and now, cataract surgery. For refractive surgery, the femtosecond laser has expanded to intrastromal ablations to treat astigmatism, Dr. Donnenfeld said, as well as the INTRACOR procedure (Bausch + Lomb, Rochester, N.Y., and Technolas Perfect Vision, Munich) treating presbyopia with incisions in the visual axis that make a steep zone centrally. For cataract surgery, new applications of the laser could include creating posterior capsulotomies to allow the IOL "to be anchored into