Eyeworld

spending almost every spare moment (I'm a solo practitioner with a fairly busy practice) on the review. About this time I knew I was discovering information that I needed to share with the ophthal- mology community. My goal was to finish the review prior to the ASCRS annual meeting. As I worked through the process, important new studies were published, such as the Able study. Dr. Able was a resident going for his PhD under the Australian team of Brendan Vote, FRANZCO, and Peter Davies, FRANZCO. They were very experi- enced FLACS surgeons and early on were very enthusiastic about the technology and reported positive re- sults in the peer-reviewed literature. But their results reported early in 2014 hit like a shock wave to anyone following the literature. Their study questioned the safety of FLACS after the so-called "learning curve" in the hands of experienced FLACS surgeons. Then a few months later another resident at a different Australian university, Dr. Okada, reported her results in the same journal. She brought into question the significance of a rounder, more-centered, and better-sized capsulorhexis. Not only was a pic- ture forming as I put the pieces of the puzzle together but new pieces kept being made. I finally got every- thing together, at least to my satis- faction, about one or two days prior to the ASCRS meeting in April and posted it on the Cataract List Serve. Dr. Chang: After you posted this PowerPoint on the ASCRS Cataract List Serve, what has been the reaction of others who read your FS laser "Cliff Notes"? Dr. Lipstock: First, I called it "Cliff Notes" because as you know they take complex literature and break it down for the weary student. I felt my review of the literature broke down a complex topic for me per- sonally, and I thought it might do the same for others. When it hit the Cataract List Serve, I was over- whelmed with the reaction. I re- ceived much gratitude for the effort spent creating the presentation, and I was thanked for providing what some referred to as the first unbiased comprehensive review of the litera- ture. There have been no corrections or arguments with me to date. One doctor did refer me to an online letter to the editor of Ophthalmology arguing against the Able study. But the reply from the authors I felt was more than adequate. Dr. Chang: What were some of the more surprising findings from your review of the published literature? Based on your research, what is your current level of interest in adopting this technology? Dr. Lipstock: As I color coded the authors red for those with financial ties and green for those without financial ties, I was surprised to see how lopsided things were in favor of red in our peer-reviewed literature. That means that most of the FLACS studies are being paid for by those trying to sell us the machines. I grew to respect the very few independent researchers out there not only for all the time and expense involved in doing the studies on their own but also for the very thick skin required when they draw conclusions counter to the party line. As for FLACS itself I was surprised that such a beautiful looking capsulorhexis (at least through the slit lamp) probably means so little clinically. I was also surprised to learn that real safety issues may be inherent in FLACS as currently being performed even by very experienced FLACS surgeons. In the middle of my review, a com- peting ASC purchased a LenSx laser and started a lot of advertising about the more "precise" FLACS procedure. At the very least all those involved in the research (both red and green) agree there is a learning curve. For LenSx it appears to be about 100 cases. Patients beware. As for me? All along I have kept an open mind. Perhaps the FLACS capsulorhexis can become smoother and safer, or perhaps not. Perhaps FLACS will have some real advantages in certain cases where the benefits outweigh the risks. But for now I'll keep doing phaco, and I remain eternally grate- ful to Drs. Kelman, Neuhann, and Gimbel. EW Contact information Lipstock: klipstock@gmail.com July 2014 ... a global view Summer Symposium Questions: Please contact Women in Ophthalmology at info@wioonline.org or at 414-359-1610. August 7-10, 2014 Lansdowne Resort Leesburg, Virginia, United States Featured Educational Sessions • Laurel Schwartz Presentation: Challenges & Rewards of Practicing in Other Parts of the World • AAO Panel: Medicine in Areas of Conflict & Disaster • Cataract Surgery • Glaucoma Surgery • Corneal Surgery • Plastic Surgery • Women in Neurosurgery Speaker • Poster Session & Complicated Case Presentations 20 + Educational Sessions 16 Networking Activities Posters and Complicated Cases 48 Register Now! wioonline.org 4 Wet Labs 4 Days 140 + MDs Minutes from Washington DC 45 What our patients continued from page 14 12-29 News_EW July 2014-DL_Layout 1 6/30/14 8:38 AM Page 16

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