APR 2015

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/493807

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to give him or her the best quality of vision and most lifestyle enhancement. My job is never to tell patients how much to pay or what it is worth for them. Some physicians have raised concerns with appearing to promote a premium lens or premium technology in general or fear sounding like they are selling something. No one wants to come across as a salesman. But I look at my role as a physician as an educator, who aims to give my patients enough under- standing of the technology to determine for themselves what its value is. For Crystalens ® , the education entails understanding what the technology provides, the range of vision it offers, and that it may decrease the need for glasses for computer work. Patients may need glasses for certain situations, but it offers a greater range of vi- sion than standard lenses can offer. 1 This way, whatever they achieve, they are happy. Patient expectations are also an import- ant part of using the VICTUS ® femtosecond laser (Bausch + Lomb). Some surgeons have raised doubts about whether femtosecond laser systems in general are worth the extra cost or are just fancy capsulotomy machines. I tell my patients that femtosecond technology gives me the best chance of getting the best outcome, but that does not mean they will always have better outcomes than manual surgery. Do I believe the VICTUS ® laser standard- izes certain steps and does those more pre- cisely than I can? Absolutely. Does it always translate to better outcomes? No. Patient education must help them understand that better outcomes are not always based on any one step of the femto- second laser. In certain situations, having a more precise arcuate incision may be a better option than manual surgery and give me a better chance of achieving the spherical outcome that I want. In other cases, it may be the perfect capsulotomy in terms of size and centration or enhance the position of the implant—and for the Crystalens ® AO and Trulign ® Toric IOLs that's important. Not every patient will derive the same benefits. Another patient could benefit from the decreased need for phaco energy. 2 This system's decreased energy can translate into significantly reduced postop corneal edema and improved visual acuities. 3 I find there are certain situations where the cataract is denser, and it might help by decreasing the phaco energy and decrease the need for postop drops, which together can improve patient satisfaction. Femtosecond technology is not just one step of the procedure that allows for better outcomes, 3 but its benefits vary by patient and could come in any one of multiple steps. Why not standardize the procedure and do what we can to get the best outcomes? I be- lieve this technology gives the best chance of getting better outcomes. It is important to educate patients preop on what these technologies do for them so they understand the value. Patient education includes discussing arcuate incisions and the fact that the VICTUS ® is more precise than I am in performing those. Another part of the patient education comes in the postop period. If they had a great outcome, I think it is important to educate patients postop on what the femto- second laser did for them. That way, when they tell their friends and family about the procedure, they will include the laser's role in it. Many times when you offer patients premium technology, they say "If I'm going to do a premium lens then why not do the entire procedure with the most precision possible?" I don't sell the laser, but I do tell them that for me, getting a perfect capsulotomy is the best way to get the best outcome. Other times pa- tients ask me what I would do for my mother. That answer is easy because I put the Crystal- ens ® in my mother's eyes. In general, I tell my patients that if cost was not an issue, I wouldn't give them the option to have the procedure without VICTUS ® and Crystalens ® /Trulign ® . The advantage of these technologies is that they are not limiting patients' vision in any way in terms of potential vision quality issues because the lens and the laser give me the best chance of achieving the best results. References 1. Crystalens AO Final clinical study report, Study #650, v2, Bausch + Lomb 2013: 1–5386 2. Conrad-Hengerer I, Hengerer FH, Schultz T, Dick HB. Effect of femtosecond laser fragmentation on effective phacoemulsification time in cataract surgery. J Refract Surg. 2012; 28(12): 879–883. 3. Chee SP, et al. Femtosecond laser cataract surgery beneficial, successful. Am J Ophthalmol. 2015; doi: 10.1016/j.ajo.2015.01.016. Dr. Singh is president of the Eye Centers in Kenosha, Wis. He can be contacted at ipsignh@amazingeye.com. This supplement was produced by EyeWorld and sponsored by Bausch + Lomb. Copyright 2015 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, publisher, or the sponsor and in no way imply endorsement by EyeWorld, ASCRS or APACRS. continued from page 3 Premium vision series 4 Caution: United States Federal Law restricts this device to sale and use by or on the order of a licensed physician. Indications: The VICTUS platform is in- dicated for use in the creation of a corneal flap in patients undergoing LASIK surgery or other treatment requiring initial lamellar resection of the cornea, for anterior capsu- lotomy during cataract surgery, the creation of cuts/incisions in the cornea in patients undergoing cataract surgery or other oph- thalmic treatment requiring cuts/incisions in the cornea, and for laser- assisted lens fragmentation during cataract surgery for nuclear cataracts, not for frag- mentation of posterior subcapsular (PSC) and cortical cataracts. Attention: Please refer to the Directions for Use for complete use instructions and safety information. Summary of contraindications: Corneal disease or pathology that precludes trans- mission of laser wavelength or distortion of laser light. Patients who do not give in- formed consent, who are pregnant or nurs- ing, have existing corneal implants, who have had any previous cornea surgery or pediatric patients. Conditions that interfere with intent to treat such as glaucoma, reti- nal disorders, rheumatic diseases, epilepsy, herpes zoster or herpes simplex keratitis, and heavy vascularization of ocular tissues. Conditions that interfere with proper docking such as chemosis, nystagmus, sig- nificant loss of stability of the conjunctiva, keratoconus, and corneal diseases requiring treatment. Conditions that may interfere with capsulotomy such as poorly dilating pupils, and anterior chamber depths (ACD) <1.5 mm or ACD >4.8 mm. Conditions that may interfere with creation of flap such as dry eye diseases, cataract, diabetes mellitus, severe acne rosacea, severe wound healing disorders, and immune deficiency diseases. Contraindicated for laser-assisted lens fragmentation of posterior subcapsular (PSC) and cortical cataracts. Victus, Crystalens, Trulign, Orbscan, Storz and Stellaris are trademarks of Bausch & Lomb Incorporated or its affiliates. All other product/brand names are trademarks of their respective owners. SUR/VCT/15/0009 3/15 VICTUS ® Femtosecond Laser

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