Eyeworld

among 30,000 cases. In contrast, "During our first 820 refractive laser-assisted cataract cases with the Catalys laser [Abbott Medical Optics, Santa Ana, Calif.], we only had two unplanned anterior capsular tears, one of which led to a vitrectomy," he said—"and the case that resulted in vitrectomy was an outlier" (a hypermature cataract). Depending upon whether or not one excludes the hypermature cataract, that re- sults in a 0.12% or 0.24% unplanned vitrectomy rate and an anterior capsule tear rate that is likely lower than the very good results seen in the manual phaco population. Surgeons will also want more data going forward on complicated cases and laser use, Dr. Krueger said. This is still a speculative area be- cause complicated cases are so much less common, he said. For example, fragmentation via phaco or a laser may not make a big difference in most cases, but differing results could lead to safer surgeries for chal- lenging cataracts, such as cases with zonular dehiscence or subluxation. Dr. Talamo said he prefers to use the laser for complicated cases, such as dense cataracts and loose zonules. He noted that some of his uses with complicated patients are off-label. Future studies should and will examine differences in safety and efficacy among the different laser platforms, Dr. Culbertson thinks. "To lump them all together and generically treat the experience with an individual machine as representative of all the machines is inaccurate," he said. Looking ahead The next evolution of femtosecond laser cataract surgery could include a greater degree of connectivity between the laser and diagnostic preplanning for improved refractive outcomes, Dr. Krueger thinks. He cited intraoperative aberrom- etry, available now from two compa- nies, as one way to meet this goal. "We will put the intraoperative imaging to work for us to help calcu- late effective lens position, and we will design special IOLs that take advantage of the precise shaping, sizing, and position of the capsulo- tomy," Dr. Culbertson said. Another up-and-coming area is Scheimpflug imaging to measure lens density. "If you could couple the information on how dense a lens is with the laser, you can have the laser treat more aggressively when it's harder and less aggres- sively when it's softer. That would make things more elegant," Dr. Krueger said. The data on femtosecond lasers will show increased sophistication because the earlier models had cer- tain limitations—and surgeons faced a learning curve, said William B. Trattler, MD, director of cornea, Center for Excellence in Eye Care, Miami. He cited, for example, how the hard dock of the LenSx (Alcon, Fort Worth, Texas) evolved into the SoftFit Patient Interface, which improves the surgical process and makes surgery more comfortable for patients. "There is continuous improvement that will move this technology forward," Dr. Trattler said. EW Editors' note: Dr. Culbertson has financial interests with Abbott Medical Optics, Alcon, and other ophthalmic companies. Dr. Krueger has financial interests with Alcon, LENSAR (Orlando, Fla.), Calhoun Vision (Pasadena, Calif.), and other ophthalmic compa- nies. Dr. Talamo has financial interests with Alcon, Allergan (Irvine, Calif.), Abbott Medical Optics, and other ophthalmic companies. Dr. Trattler has financial interests with LENSAR, Abbott Medical Optics, Allergan, and other ophthalmic companies. Dr. Vote has financial interests with Novartis (Basel, Switzerland). Contact information Culbertson: wculbertson@med.miami.edu Krueger: Krueger@ccf.org Talamo: jtalamo@lasikofboston.com Trattler: wtrattler@gmail.com Vote: eye.vote@me.com June 2014 32-41 Feature_EW June 2014-DL_Layout 1 6/3/14 12:31 PM Page 33

• Cover