Eyeworld

EW CATARACT 28 June 2015 Device focus by Michelle Dalton EyeWorld Contributing Writer registration, cataract density im- aging, customized fragmentation patterns, and arcuate incision planning. The system is the first to enable wireless transfer of data from preop corneal measurements to the femto laser. Dr. Donaldson said improve- ments in phaco fluidics are exciting, too. At Bascom Palmer, she's moved from the Infiniti to the Centurion (both Alcon), and the newer fluidics on the Centurion "have improved our outcomes by allowing us to use less energy during phaco." Intraoperative aberrometry Intraoperative aberrometry has some potential, Dr. Hoffman said, but mostly when he's placing IOLs in post-LASIK or post-PRK patients. In the post-RK eye, however, "you're stretching these incisions, and you're changing the curvature of the cornea when you're doing your pha- co. So if you measure the wavefront aberrometry in a post-RK eye, it's not going to be the same 2 months later." to guess where 12 and 6 o'clock are," he said. The Callisto is "a much more precise measurement." Dr. Donaldson said Alcon (Fort Worth, Texas) is "probably the best example of integration," because the company bought the LENSTAR technology from Haag-Streit (Koniz, Switzerland) and has since acquired the ORA intraoperative aberrometry system from WaveTec. "Surgeons can now take the in- formation from the LENSTAR, input it into the Verion [Alcon], head to the femtosecond LenSx [Alcon], and the operating microscope and all the information seamlessly flows as the preoperative plan is translated into the operating room," she said. "Zeiss is doing the same thing with its Callisto, IOLMaster, and Lumera, and Bausch + Lomb [Bridgewater, N.J.] is doing the same thing with the VICTUS laser and the Cirle system." LENSAR (Orlando, Fla.) received 510k clearance from the Food and Drug Administration for a suite of 5 new application technologies integrated into the company's laser system. The 5 new applications are wireless integration with the Cassini corneal shape analyzer (i-Optics, The Hague, the Netherlands), iris regardless of which manufacturer developed which piece of the puzzle. "The nomogram becomes more robust as more postoperative data is entered into the system," she said, and that translates to better patient outcomes. Technology improvements Dr. Hoffman has been impressed with devices that measure both anterior and posterior curvature to provide the overall corneal pow- er, "which is very useful for toric IOL calculations," he said. "We're looking at retrofitting our micro- scope with a Callisto system just so we don't have to keep marking our patients." Jena, Germany-based Carl Zeiss Meditec's Callisto computer-assist- ed surgery system incorporates the company's IOLMaster device and the OPMI Lumera microscope, he said. "By working in harmony, the Callisto will tell you where to line up the toric IOL," Dr. Hoffman said. This small "but urgently needed step forward eliminates surgeon frustra- tion." Typically, patients head into the operating room 30–40 minutes after their cornea has been marked, "so the mark has spread and you have Beyond femtosecond lasers, cataract surgeons have a bevy of new options to consider A dd enough incremental improvements together and ultimately you will have a significant step forward. "Five or 10 years from now, that's how we'll view the past few years in cataract device improvements," said Richard S. Hoffman, MD, clinical associate professor of ophthalmology, Casey Eye Institute, Oregon Health & Science University, and in private practice at Drs. Fine, Hoffman & Sims, Eugene, Ore. A "true accommodating lens" would be a "big jump forward," he said, but year-on-year there are not likely to be major improvements in lens technologies. He is, however, intrigued with dropless cataract surgery. With the cost of some generic drugs just as expensive (and in some cases, more expensive) as the named version, Dr. Hoffman said he expects more surgeons to slowly move over to dropless cataract surgery. Kendall E. Donaldson, MD, Bascom Palmer Eye Institute, Mi- ami, Fla., is taking a more reserved approach and has not yet adopted the dropless technique, calling it a "promising but somewhat contro- versial topic because it requires plac- ing a needle through the zonules. I've held out on incorporating this into my practice because it seems as cataract surgeons we spend our whole life trying to avoid disruption of the zonules." In general, however, Dr. Donaldson thinks the concept is long past due, especially as it alle- viates the rising cost of medications for the patient. Both surgeons agree that the integration of technology over the past year or so has been the key to improving cataract surgery. "Combining technology among different companies and getting the companies to work cooperatively is crucial to achieving our best results," Dr. Donaldson said. For instance, integrated cataract suites allow sur- geons to enter postop data to create their own customized nomograms, What's new in cataract suites A toric IOL aligned using the Callisto system in the presence of significant stromal hydration of incisions Source: Richard S. Hoffman, MD continued on page 30

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