Eyeworld

45 EW FEATURE After analyzing the possible causes, Dr. Nagy and the laser physicists concluded that the patient interface needed to be redesigned. "A lot of work was done until we found the current SoftFit in- terface [Alcon, Fort Worth, Texas], which provides better corneal wound structure, less postoperative conjunctival redness, and in 97% of cases, a free-floating capsulotomy," he said. Robert J. Cionni, MD, medical director, The Eye Institute of Utah, Salt Lake City, started performing laser cataract surgery with the first commercially available LenSx laser (Alcon) in 2011. Initially, capsuloto- mies and lens chop were not always complete, he said, but that changed as the technology advanced and patient interfaces improved. The pristine, strong capsulotomies that lasers produce now and the ability to use little to no ultrasound for lens removal are clear advantages when dealing with mature cataracts and cases where there is zonular compro- mise, he said. Dr. Talamo felt that the ear- ly patient interfaces were not as user-friendly as they needed to be— they were harder for the surgeon to use and uncomfortable for the patient. Docking time was also an issue. With the first lasers, it took about 5–7 minutes to position the patient, dock the laser to the eye, and deliver treatment—a length of time that was manageable, but not ideal. As the interfaces evolved, how- ever, they have become more sophis- ticated, easier to use, and more com- fortable for the patient, dramatically reducing docking times. "Now, the time from when I walk into the room until I exit the room is under 2 minutes, with the actual laser time being less than 30 seconds," Dr. Cionni said. The pace of adoption Ophthalmic surgeons have always had some skepticism regarding new technology and some level of resistance to change, even with tech- nologies considered indispensable today, such as phaco and even IOLs. "In the operating room in par- ticular, our existence is very stylized and repetitive, and that's probably a good thing because that's how [we] make sure that care is delivered in a reproducible and highly safe and effective manner," Dr. Talamo said. "When you have anything that takes a surgeon and his or her team out of their comfort zone and introduces new workflow patterns and new skills to master, that always gets pause." Laser cataract surgery has seen its share of skepticism, and in a way, that makes sense, Dr. Talamo said— when you take a highly evolved, efficient procedure and add expen- sive capital equipment that disrupts the workflow, skepticism is to be expected. While the pace of laser cataract surgery adoption discourages some physicians and those in industry, Dr. Talamo does not feel this way. "When you look back at what happened with the transition from manual extracapsular cataract sur- gery to phacoemulsification, that transition took a lot longer, and I would argue [it] encountered many more bumps in the road than the introduction of laser cataract sur- gery," he said. "I think that we are on or ahead of course for seeing the technology that's going to become widespread and mainstream in our work life in the years to come." The economics of laser surgery are still an issue for many surgeons, but surprisingly, patients have quickly embraced the technology, despite the added cost—just as they embraced it for refractive surgery. "What lasers had done for LASIK surgery is make flap cutting safer and more predictable," Dr. Talamo said. "It took some time for the refractive surgery community to come around to that idea, but interestingly, very quickly, patients gravitated toward it. They intuitive- ly understood the concept of using lasers in medicine and surgery." To Dr. Slade, the biggest benefit of the technology is that it has limit- less potential. "To me, this is an enabling tool," he said. "There's only so much you can do with a metal blade. But when you go into a digital area, the sky is the limit." EW Editors' note: Drs. Cionni, Nagy, and Slade have financial interests with Alcon. Dr. Talamo has financial interests with Abbott Medical Optics (Abbott Park, Ill.) and Alcon. Contact information Cionni: 801-266-2283 Nagy: nz@szem1.sote.hu Slade: sgs@visiontexas.com Talamo: jtalamo@lasikofboston.com July 2015 Femto cataract clinical update Stephen Slade, MD, Houston, performs the first laser cataract surgery in the U.S. using the LenSx laser February 2010 Study shows integrating OCT with femtosecond lasers increases safety and precision during laser cataract surgery November 2010 FDA approves LENSAR laser (LENSAR, Orlando, Fla.) for lens fragmentation and anterior capsulotomy March 2011 Catalys laser platform (Abbott Medical Optics) receives FDA approval December 2011 Victus laser platform (Bausch + Lomb, Bridgewater, N.J.) receives FDA approval July 2012 More than 1,000,000 laser cataract procedures performed worldwide; docking time less than 2 minutes 2015

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