Eyeworld

EW FEATURE 29 Dr. Lane, who was slated to get the LenSx Laser by June, would like to see how, or if, added precision will eventually translate into better surgical outcomes with the LenSx model as well as with other models. "Whether that added precision is equated with improved results re- mains to be seen," he said. OptiMedica's Catalys Precision Laser System William W. Culbertson, M.D., pro- fessor of ophthalmology, and direc- tor, cornea and refractive surgery services, Bascom Palmer Eye Insti- tute, Miller School of Medicine, University of Miami, has worked with a team that has performed more than 100 cataract surgeries with the OptiMedica model in the Dominican Republic over a 2-year span. "We are able to precisely per- form one of the most inconsistent parts of the surgery, which is the an- terior capsulotomy," he said. "Laser-assisted cataract surgery is also customizable. We are able to size and position the capsulotomy in the way we want," Dr. Culbertson said. "Theoretically, if we can make the capsulotomy of a consistent di- ameter and position then we may have better control over the effective lens position, which in turn could lead to more predictable refractive outcomes." In addition to better precision and customizability, Dr. Culbertson said his studies have demonstrated that the ability to soften and seg- ment the nucleus with the laser de- creases the number of intracameral manipulations necessary to emulsify nuclear fragments, and decreases the phaco energy used by about 40%. The laser also helps facilitate the reduction of astigmatism through re- laxing incisions and may contribute to more dependable incision closure through reverse bevel "tongue-in- groove" type self-sealing incisions. "We have shown that these steps are performed more precisely and accurately than would be done manually. Although it's not robotic surgery, it does set the stage to possi- bly make outcomes better and safer," Dr. Culbertson said. The laser's high-resolution ocu- lar coherence tomography (OCT) renderings of corneal thickness, the anterior chamber, and the posterior surface help boost accuracy, Dr. Culbertson said. This imaging is done with the help of Catalys' Liquid Optics Interface, which docks the patient to the system and pro- vides an undistorted path for OCT imaging by filling corneal surface ir- regularities with liquid and creating a wide field of view, according to OptiMedica's website. "We have an interesting system for coupling the laser to the eye with the immersion waterbath," Dr. Culbertson said. "We get accurate measurements of the eye, the ante- rior chamber, and the position of the pupil, limbus, and lens unper- turbed by the coupling device." This device was created after a fixed curved suction device was originally used that coupled directly with the cornea. However, imaging of the an- terior chamber was distorted by folds in the posterior cornea, and the laser could not focus well. This is what led to the creation of the Liquid Optics Interface, Dr. Culbertson said. Although Dr. Culbertson praises the OptiMedica system and fem- tosecond laser technology for cataract surgery in general, he be- lieves that offering these advantages to patients still presents challenges. "It's an expensive technology. There are various possible strategies for adapting this into a practice in terms of logistics and economics, and I don't think those have been clearly delineated yet," he said. EW Editors' note: Dr. Culbertson has finan- cial interests with OptiMedica. Dr. Donnenfeld has financial interests with Alcon. Dr. Fishkind has financial inter- ests with LensAR. Dr. Lane has finan- cial interests with Alcon. Dr. Reddy has no financial interests related to his comments. Contact information Culbertson: 305-326-6364, wculbertson@med.miami.edu Donnenfeld: 516-446-3525, eddoph@aol.com Fishkind: 520-293-6740, wfishkind@earthlink.net Lane: sslane@associatedeyecare.com Reddy: prasadkasureddy@yahoo.com February 2011 July 2011 Laser-assisted cataract surgery Figure 2. Symmetrical femto capsulorhexis compared to freehand capsulorhexis Source: William J. Fishkind, M.D. Figure 3. 3D-CSI images of cataracts Source: William J. Fishkind, M.D. International point of view Hyderabad, India R eproducibility and accuracy are two of the top strengths of the Technolas Customlens laser, said Prasad Kasu Reddy, M.D., Hy- derabad, India. "The capsulotomy can be exactly centered with excellent circular- ity and diameter, and this has helped me enormously with my premium IOLs," said Dr. Reddy, who has performed more than 200 surgeries with the technology since November 2010, and has used the Technolas technology with multifocal, accommodative, and toric IOLs. The technology also has real-time OCT, which Dr. Reddy said helps him to see the anterior and posterior capsules clearly. Dr. Reddy praised the technology's fragmentation and liq- uefaction abilities. "Like any senior surgeon, I am used to direct chopping. My observation is that you don't need to chop any- more, and all that is needed is separation into four fragments and phacoemulsification," he said. "Later I tried crosses and cir- cles for liquefaction, and this way I could reduce the effective phaco timings." Dr. Reddy would like to see future modifications to make the technology more user-friendly and more customized.

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