EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/387844
EW CATARACT 38 by Lauren Lipuma EyeWorld Staff Writer White paper provides comprehensive guide to femto cataract surgery Perfectly circular 5.0 mm capsulotomy created with femtosecond laser Source (all): Kendall E. Donaldson, MD Review article published in JCRS offers practical information for surgeons considering incorporating the technology into their practice T he November 2013 issue of the Journal of Cataract & Refractive Surgery featured the white paper "Femtosec- ond Laser-Assisted Cataract Surgery" sponsored by the ASCRS Cataract Clinical Committee. The review provides anterior segment surgeons with practical information about the technology and how best to incorporate it into daily practice. "Femtosecond laser-assisted cataract surgery is gaining popular- ity and is the newest breakthrough technology to have emerged in cataract surgery," said Sonia Yoo, MD, professor of ophthalmology, Bascom Palmer Eye Institute, Miami, and co-author of the paper. Since its approval by the FDA in 2011, use of the technology has raised many clinical and financial issues among anterior segment surgeons. "The introduction of this technology has forced cataract surgeons to reevaluate their own practices," said lead author Kendall Donaldson, MD, medical direc- tor, Bascom Palmer Eye Institute, Plantation, Fla. "At times it may be difficult to sort through indust y bias to decipher true attributes and deficiencies of new technology when financial interests are at stake." The goal of this paper, she said, was to provide cataract surgeons with an unbiased perspective on laser cataract surgery, to assist them in making the best choice for their practice. The review process The authors reviewed the published literature on femtosecond laser- assisted cataract surgery, includ- ing original articles describing the technique, benefits, learning cu ve, complications, and safety of the procedure, as well as articles com- paring laser-assisted surgery with traditional phacoemulsification. "Our goal was to provide a guide for surgeons to understand how to choose the most appropriate platform for their needs and how to best incorporate laser technology into their cataract surgery practice," said Dr. Donaldson. The reviewers also interviewed surgeons who were pivotal initial users of the 4 laser platforms. The surgeons contributed videos for each platform, which are accessible through the JCRS website. The article opens with a dis- cussion of how femtosecond laser technology works and a comparison of the 4 available laser platforms, explaining the differences in dock- ing, imaging, patient interface, and laser treatment. The authors com- pare and contrast aspects of laser and traditional phacoemulsification, including incisions and capsulorhex- is, hydrodissection, chopping versus divide-and-conquer, and cortical removal in both types of procedures. The authors then describe how to approach complications and challenging cases, including orbit, neck, and back issues, small pupils, suction loss, incomplete capsulot- omy, and computer malfunction. They review laser-assisted surgical outcomes, including capsulotomy, lens fragmentation, incisions, visual acuity, and macular edema. Final- ly, the authors discuss options for incorporating a femtosecond laser into a practice, including location, logistics, and scheduling. continued on page 40 The four femtosecond laser platforms October 2014 Catalys Precision Laser System (Abbott Medical Optics) LENSAR Laser System (LENSAR) LenSx Laser System (Alcon) VICTUS Femtosecond Laser Platform (Bausch + Lomb)