Eyeworld

EW MEETING REPORTER 82 September 2011 look forward to what the future holds. Kerry D. Solomon, M.D., Charleston, S.C. Q: Do you redrape the patient when moving from the femto procedure to the phaco room? If you make a femto clear corneal incision, do you add any addi- tional antisepsis when you move to the phaco OR? Is there any concern about endophthalmitis with the additional moving of the patient? A: The patient is reprepped and re- draped in the operating room. The typical pre-op surgery prep is used with 5% povidone-iodine instilled in the eye, and then the skin is prepped and the drape applied. Since the eye is not opened by the laser, I am no more concerned about endophthalmitis than I am with any other standard cataract surgery. Stephen S. Lane, M.D., Minneapolis Q: Is the docking sterile? Can you prep the patient before the laser then not reprep prior to cataract surgery if it is all done in the same room? A: The docking process is not sterile. While the cone that contacts the eye is packaged sterile and the eye has been prepped, the procedure is not strictly sterile in the same way that a LASIK procedure is not strictly ster- ile. If the procedure is done in an OR and all personnel are appropriately gowned and gloved and the patient prepped and draped in the usual sterile fashion and the patient is simply moved from the laser to the microscope to complete the phaco, a redrape and reprep is probably not necessary. However, this is not the way this will usually be done, as the laser procedure will likely be done in a clean but not sterile room, and reprepping and redraping should be performed. Stephen S. Lane, M.D., Minneapolis Q: I have been told the femto laser can't penetrate very brunescent lenses well. Were hypermature (4+) or white lenses studied? A: As long as a good red reflex can be obtained, the laser penetrates the lens well and effects a good frag- mentation. White lenses prevent penetration of the laser. Still, capsu- lotomy can be performed safely as can the corneal incisions in such pa- tients. Robert J. Cionni, M.D., Salt Lake City Q: Were any intraoperative floppy iris syndrome (IFIS) patients done by any of the faculty? A: Yes. As long as the pupil dilates to at least 5.5 mm, all aspects of the laser have been successful. Some de- velop pupil constriction after the laser energy is applied and therefore require intracameral dilating agents and/or mechanical pupil dilating de- vices after the laser. Robert J. Cionni, M.D., Salt Lake City Q: Are any of the panel members com- bining this technology with accommo- dating IOLs? Can they discuss their specific experiences and outcomes? A: I have used femtosecond refrac- tive cataract surgery on many pa- tients with multifocal IOLs with excellent results. I have only had the opportunity to implant one Crystalens (Bausch & Lomb, Rochester, N.Y.) with a femtosecond capsulotomy. The anatomic results were excellent, but I did not see any difference in the patient's distance or reading vision. Eric D. Donnenfeld, M.D., East Meadow, N.Y. Q: How long can I wait until I start the surgery (manual procedure)? A: In general, the sooner we start the manual procedure, the better it is for the patient. The pupil can become more miotic if there is a long wait between the femtosecond lens dis- ruption and the lens removal. We try to do the surgery within 15 min- utes, but I would not recommend waiting more than an hour. Eric D. Donnenfeld, M.D., East Meadow, N.Y. For the complete webinar, please go to www.eyeworld.org/replay.php. Editors' note: No financial support was received to produce the femtosecond webinar series, and the program topics were developed based on questions re- ceived from members. Dr. Cionni has financial interests with Alcon (Fort Worth, Texas). Dr. Donnenfeld has financial interests with Alcon, Abbott Medical Optics (Santa Ana, Calif.), and Panelists answer questions from femto for cataract webinar Reporting live from the EyeWorld webinar, The future of laser-assisted cataract surgery: Clinical results and patient flow, June 8, 2011 by Jena Passut EW Staff Writer M any questions were asked and answered during the second ASCRS and EyeWorld femtosecond for cataract surgery webinar titled, "The future of laser-assisted cataract sur- gery: Clinical results and patient flow." The inquiries from attendees that weren't addressed on the spot were given to faculty members to an- swer. The following are the answers. Q: How does the faculty think optome- try will view the femto component—as something that falls in their scope of practice? A: Optometrists and ophthalmolo- gists have embraced laser technolo- gies over the years. Lasers have added precision to our current treat- ment options, from argon retinal lasers, ND:YAG lasers to corneal re- fractive excimer and femtosecond lasers. I believe all eyecare providers, and patients alike, will embrace femtosecond laser refractive cataract surgery if it is shown to be safe and effective with an added improve- ment in customization and preci- sion. Ophthalmologists, optometrists, and patients have come to expect improved outcomes as technology advances. Scope of practice is an entirely different issue. We should not fear a new scientific advancement in terms of scope of practice issues. If that were the case, where would we be today? We would possibly be performing surgi- cal openings of the posterior capsule instead of an outpatient procedure, possible radial keratotomy, or even extracapsular cataract extraction. Obviously, preventing the current advances in medicine would not have been in the best interest of our patients. This is how the field of medicine has progressed over time. We should not cloud our judgment, nor dampen our innovation, over scope of practice issues. Science will advance. Technology will advance. This is a great thing. This is what makes the practice of medicine so special. Scope of practice is an en- tirely different issue, one that should be dealt with directly, proactively, and with a cohesive, unified front. Femtosecond laser refractive cataract surgery has the potential to bring re- fractive cataract surgery to an en- tirely new level for our patients. I by Jena Passut EyeWorld Staff Writer

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