Eyeworld

M y equipment selection for cataract surgery begins with asking what I need to maximize my patients' potential for good visual acuity, overall outcomes, and—most importantly— quality of vision. When I look at lens options, for in- stance, like multifocals, standard monofocals, accommodating lenses, or torics, my focus is on which will give me the best chance of achieving that 20/happy patient. That's the bottom line. Monofocal lenses are always my first choice, especially as a glaucoma specialist who has a lot of glaucoma patients. The first thing you lose in glaucoma is contrast sensitivity so I avoid IOLs that could worsen that loss. We also know that monofocals will not exacerbate dry eye, ocular surface disease, or macular issues that the patient could develop in the future. That is why, among premium lenses, I prefer the Crystalens ® AO and Trulign ® Toric IOLs (Bausch + Lomb, Bridgewater, N.J.). But why offer premium lens technology in the first place? My approach is to offer ev- ery patient the technology with the potential 3 continued from page 2 The VICTUS ® femtosecond laser con- tinues to provide the multiple roles we have come to expect, which includes both LASIK flaps for the younger patients and cataract incisions and cataract lens fragmentations for older patients. In the case of LASIK, the system replaces mechanical incisions, during which the sur- geon loses visualization for 30 seconds. When you take the microkeratome off you hope the cut was made, but you don't see the cut as it is being made because the equipment covers up each other. With other femtosecond lasers you can watch the image on the screen, but you are always a couple of seconds behind what is happening. Now, for the first time, the LASIK surgeon making the flap has both the live screenshot and a real-time live OCT. This view and the cross section allows you to detect whether any bubbles are going into the an- terior chamber, as well as whether the cut is occurring too deeply or in a different position than you wanted. The system allows us to compensate for individual patient challenges in new ways. If I see a patient who is moving and endangering the alignment I had at the beginning, I will stop and reposition the patient. In the past and with other femtosecond systems I might not have known that was occurring until part of the cut was made. These latest advantages are important because when my patients are paying out-of- pocket costs on top of their insurance they expect perfection, and we want to have the best chance of delivering it. The most common source of our patients is word of mouth from friends. People now come in and because of the Internet and word of mouth say "Here is how I want this, I expect to see as well as my friend and I expect it now." It is a little more demanding crowd and a much more knowledgeable crowd. These patients are asking about options for distance vision and up close, and some are looking for complete spectacle freedom. If I can have something that's going to be that much more accurate, I am going to be more likely to meet my patients' expectations. On the LASIK side, we used to have a lot of prospective patients who, due to the thin- ness of their corneas, were unable to qualify for LASIK. However, the margin of error for mechanical flaps was up to 40–50 microns. The standard deviation on this laser that I have studied is less than 6 microns, which gives me a lot more confidence to offer a pro- cedure that is comfortable and that has faster healing. The use of the VICTUS ® laser for both flaps and cataracts is beneficial for my practice to be a one-stop shop for my patients. I used to have to buy two pieces of equipment, and this piece of equipment can do it more accu- rately out of one box. That's going to be more practical for the surgeon and a little more cost efficient for the practice. Another key difference is that we're now able to accurately and predictably treat people with such big prescriptions that they are handicapped if they lose their glasses. The fun difference for me is I am going from patients saying "That wasn't that bad" to now getting hugs. It's life changing. Dr. Endl is a partner at Fichte, Endl and Elmer Eye Care in Amherst, N.Y. He can be contacted at mpderme@aol.com. Offering patients the best possible outcomes by Inder Paul Singh, MD Eye following VICTUS ® femtosecond laser use to create incisions, capsulotomy, and lens fragmentation prior to cataract removal. Of note is the lack of a "white ring" around the anterior capsulotomy. Less adhesion to the cortex becomes important during I/A to help ease removal. Source: Inder Paul Singh, MD continued on page 4

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