Eyeworld

EW MEETING REPORTER 82 June 2015 Supported by Reporting from the Singapore National Eye Centre (SNEC) 25th Anniversary International Meeting, May 22–24, 2015, Singapore Reporting from the SNEC 25th Anniversary International Meeting Mastering femto phaco The Cataract Day sessions includ- ed a MasterClass on femtosecond laser-assisted phacoemulsification surgery—a course, said moderator Ronald Yeoh, MD, Singapore, that has become something of a staple of the annual meetings of the Ameri- can Society of Cataract & Refractive Surgery (ASCRS) and the Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS). Dr. Yeoh started the session by recapping the fundamentals of femto phaco, beginning with why surgeons—most of whom are already accomplished phaco surgeons, achieving excellent results every time—should even consider shifting to femto. Reviewing his own manual phaco cases, Dr. Yeoh concluded that while "we'd like to think all our CCCs result in complete 360-degree coverage," this is not actually the case. Many of his cases were ec- centric, resulting in suboptimal results—and dissatisfaction—in at least one case. That one case was for Dr. Yeoh the impetus for starting femto. To date, he admitted, it has been difficult to show a clear advantage for routine uncomplicated cataracts. Nonetheless, there are certain case types for whom the femtosecond laser provides a clear advantage. Samuel Masket, MD, Los An- geles, said these cases were in eyes with a compromised endothelium, shallow anterior chamber, dense cataracts (although certain black cat- aracts are beyond the abilities of the femtosecond laser), zonulopathy, and capsule issues. Recalling his own experience with the transition from extracap- sular cataract extraction (ECCE) to phaco, Dr. Masket said that he believed the "proof" of femto pha- co's advantage over manual phaco would be a long time coming, but that even today he thinks that the major stumbling block is the cost of making the shift to femto phaco. Dr. Yeoh agreed. He also remem- bered how the first paper to show definitive proof of the advantage of phaco over ECCE came out when surgeons had already been per- forming phaco for 10 years, and he believed that were it not for the cost, every single cataract surgeon would be doing femto phaco today. Editors' note: Dr. Masket has finan- cial interests with Alcon (Fort Worth, Texas). Dr. Yeoh has financial interests with Abbott Medical Optics (Abbott Park, Ill.) and Alcon. Debating cataract controversies The Cataract Day program conclud- ed with the first scientific sympo- sium of the Singapore National Eye Centre (SNEC) 25th Anniversary International Meeting in Singapore. The topic pitted a pair of the world's top experts against each other on each of 3 controversial topics in cataract surgery. Samuel Masket, MD, Los Angeles, led the charge, arguing for intraoperative aberrometry. He began his argument by describing how LASIK outcomes have reset the bar for cataract surgery, with around 94% of eyes within 0.55 D of target refraction. Meanwhile, the current U.K. benchmark for cataract surgery out- comes is 55% of eyes within 0.55 D. One of the major sources of IOL power error is aphakic refraction—a measure provided by intraoperative aberrometry through a modified vergence formula and, in the partic- ular case of the Optiwave Refractive Analysis system (ORA, Alcon), a pro- prietary algorithm, Dr. Masket said. Use of the ORA, he said, while requiring surgeons to adhere to certain technical guidelines during surgery for optimal results, provides "remarkable accuracy." Fam Han Bor, MD, Singapore, however, is not convinced. He argued that while ORA is good to have, it is not essential. Rather, Dr. Fam said that optical biometry and corneal tomography are the true essentials, even serving as necessary backup for intraoper- ative aberrometry when measure- ments fail. Perhaps reflecting the real-world penetration of the technology in the Asia-Pacific region to date, the audience vote fell heavily on the side against the necessity of intraop- erative aberrometry. Next, Chee Soon Phaik, MD, Singapore, and Ti Seng Ei, MD, Singapore, took turns rehashing the current data and experience sup- porting the opposing sides of the still-heated debate on femtosecond laser-assisted phacoemulsification. With regard to this debate, the audience was more evenly divid- ed, though still falling on the side against. Finally, Ronald Yeoh, MD, Sin- gapore, and Graham Barrett, MD, Nedlands, Western Australia, restat- ed their arguments for multifocal IOLs and monovision, respectively. While Dr. Yeoh is hesitant to say categorically that multifocal IOLs are better than monovision—despite the ability of multifocals to achieve 100% spectacle independence and the inclusion of the new extended range of vision IOLs such as the Tecnis Symfony (Abbott Medical Optics)—multifocals certainly have a place in refractive cataract surgery. The key, he thinks, is in choos- ing patients carefully and having a strategy in place to manage dissatis- fied patients. That said, around 94% to 95% of Dr. Yeoh's patients achieve total spectacle independence, and most are satisfied with their vision. Dr. Barrett thinks that Dr. Yeoh's approach is entirely reasonable— there's a wide variety of options for patients, and Dr. Yeoh carefully matches patient to option.

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