Eyeworld

EW MEETING REPORTER September 2011 83 FRIDAY General sessions of the ASCRS/ EyeWorld Town Hall Meeting on Laser-Assisted Cataract Surgery opened Friday, July 15, 2011, with presentations by panelists experi- enced with the technology, as well as those surgeons who debate its present usefulness. Attendees were encouraged to ask questions and dis- cuss their opinions with the faculty. Examining the science/debates Eric D. Donnenfeld, M.D., Long Island, N.Y., opened the first session by inviting everyone to participate in roundtable discussions that culled participants' wish lists for what they wanted to get out of the meeting. As part of a real-time survey, 88% re- sponded that they believed there is room for improvement in the cataract surgery procedure, but indi- cated that they wanted more infor- mation. When asked if there is a clear pathway to reimbursement, approximately 75% said they didn't think so. Following the survey, panelists turned toward the science of and de- bates surrounding laser-assisted cataract surgery. Barry S. Seibel, M.D., Los Angeles, opened with a presentation on the current status of cataract outcomes and where the procedure needs to go from here. Using an exhaustive literature study undertaken by David F. Chang, M.D., Dr. Seibel attempted to answer the question of whether femto tech- nology would be an improvement over current manual rates. In contrast to manual cataract surgery, Dr. Donnenfeld said that for him, "Cost and increased time are the only downsides to using the laser, and that's something I'm will- ing to tolerate." Stephen G. Phillips, M.D., Seat- tle, continued by asking some criti- cal questions: Can a surgeon buy services a la carte? For example, is it possible to purchase services for per- forming capsulorhexis and nuclear softening, but not have to pay for incisions and peripheral corneal re- laxing incisions (PCRIs)? Will com- panies offer combination laser packages that will give surgeons ac- cess to other applications of the laser? He concluded his presentation by comparing laser-assisted cataract surgery to the now-retired super- sonic passenger aircraft Concorde. "The Concorde was fabulous tech- nology but it didn't pay for itself," he said. Steven G. Safran, M.D., Lawrenceville, N.J., presented his more critical perspective on laser-as- sisted cataract surgery, saying that he was skeptical that outcomes could be significantly improved upon. "There are some advantages to what we're doing now," he said. Dr. Safran said that the empha- sis should be on gathering data. He also stated three major hurdles that have to be cleared: the need to pre- serve fee structure, the need to pre- serve the surgical domain, and the need to make advocating for the pa- tient a priority. "Are we really advocating for patients when we sell them a $2,000 rhexis or LRI?" he asked. Current status of femtosecond laser technology In the second session of the day, consultants for each of the main companies in the field of femtosec- ond laser technology presented their perspectives and experiences with the different lasers currently avail- able. Dr. Donnenfeld, who currently uses the LenSx Laser (Alcon, Fort Worth, Texas), opened the session with a summary of the suggested benefits that those who are advo- cates of laser-assisted cataract sur- gery are currently touting: more precise and reproducible relaxing in- cisions, better effective lens posi- tioning, a more precise capsulotomy that translates into better refractive results. Jonathan H. Talamo, M.D., emphasized the importance of mak- ing certain that the capsulotomy is complete and that no tags remain. He also compared laser docking for cataract surgery with docking used in LASIK, stating that cataract sur- geons need a wider field of view to view the limbus reliably. Dr. Talamo concluded that it is important that one monitor stability of docking and suction during the procedure. Harvey Uy, M.D., Makati, Philippines, presenting his video demonstrating the use of the LensAR system (Winter Park, Fla.), empha- sized that lower levels of laser energy used in laser-assisted cataract surgery replace higher levels of ultrasonic energy. He said to those new to laser-assisted cataract surgery, they will have three steps to master: docking, imaging and measure- ments, and laser applications. All agreed that patient selection is important—a patient who is non- compliant, anxious, or incapable of controlling eye movement may not be the ideal patient for the proce- dure. ASCRS/EyeWorld Town Hall Meeting on Laser-Assisted Cataract Surgery Reporting live from the ASCRS/ EyeWorld Town Hall Meeting on Laser- Assisted Cataract Surgery, Chicago, July 14-17, 2011 Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team. September 2011 continued on page 84 Panelists continued from page 82 LenSx (Aliso Viejo, Calif.). Dr. Lane has financial interests with Alcon. Dr. Solomon has financial interests with LensAR (Winter Park, Fla.). Contact information Cionni: rcionni@theeyeinstitute.com Donnenfeld: eddoph@aol.com Lane: sslane@associatedeyecare.com Solomon: kerry.solomon@carolinaeyecare. com

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