Eyeworld

EW CATARACT 45 February 2015 patterns in the center of the lens." Dr. Schumer finds this gives him the most flexibility and ease in remov- ing the lens material. "I like the mul- tiple layers of sectioning," he said. "It's giving me smaller pieces at the phaco tip where a large percentage of them are being aspirated only." Other nuances The fragmentation patterns are not the only new thing to master, Dr. Schumer noted. Initially, he found that some of the capsulorhexes he created with the Victus were incom- plete. "I learned that has everything to do with the initial applanation of the eye," Dr. Schumer said. "The Victus uses a water interface, so if you over applanate during the initial engagement of the patient inter- face to suction clip you will create wrinkles in the cornea." This can preclude the energy from penetrat- ing efficiently through the cornea to perform the delicate capsulorhexis. To avoid this, Dr. Schumer urges surgeons who notice the folds on the OCT to lower the bed slightly and reduce the applanation pressure. "You will see on the OCT that folds in the cornea resolve. Since making those adjustments, we've seen 100% free capsulorhexis," Dr. Schumer said. In addition, when performing limbal relaxing incisions with the femtosecond laser, Dr. Schumer initially did not see any effect postoperatively. The problem, he realized, was that he did not manually open up these incisions. "We learned that you have to take a Sinskey hook to open up these incisions in order to see the re- fractive effect that you're trying to produce to correct astigmatism." Dr. Schumer's outcomes with the femtosecond technique overall have been excellent. "It's not that our outcomes were bad with manual cataract surgery, but we are certainly not losing ground by using a femtosecond laser," he said. "The advantages we talk about with patients are the reduced energy into the eye in the form of ultrasound phaco and the increased precision for the incisions and the capsulorhexis." Likewise, Dr. Bowden finds that outcomes have been very good. "We had great outcomes before, and I would say that there are more corneas that are clearer (now) as a function of less manipulation and less phaco energy delivery," he said, adding that patient satisfaction also appears greater. Ultimately, all the different femtosecond laser platforms will offer essentially the same fragmenta- tion patterns, Dr. Bowden thinks. "The fragmentation pattern is going to be surgeon preference and nuclear density driven," he said. "I think the adoption of the femto laser technology would be appropri- ate for most surgeons if it can be in- troduced in a way that complements their existing surgical technique or enables them to embrace other modifications in their technique that would improve their overall outcomes." EW Editors' note: Drs. Bowden and Schumer have financial interests with Bausch + Lomb. Contact information Bowden: fbowden3@hotmail.com Schumer: schumer@revisioneyes.com Streamlines data calculation and communicates planning seamlessly to your LenSx ® Laser and/or surgical microscope to help you make the right clinical decisions. PROCESS: WHAT CAN A SEAMLESS SURGICAL PROCESS DO FOR YOUR OUTCOMES? From imaging to planning to guiding your surgical execution, the VERION™ Image Guided System can help reduce the potential for refractive error. Now you can confi dently make a surgical plan that will help you deliver the corrected vision your patients expect and deserve. VERION™ Image Guided System Process Map © 2014 Novartis 12/14 ORA14059JAD-B

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