Eyeworld

EW FEATURE 46 Femto cataract clinical update July 2015 by Vanessa Caceres EyeWorld Contributing Writer AT A GLANCE • Femtosecond laser systems for cataract surgery continue to evolve to make surgery easier, faster, and more precise, according to some surgeons. • Recent upgrades to femto lasers for cataract surgery include real-time OCT, more sophisticated preop surgical planning systems, wireless transfer of data, and broader uses for the lasers. • Upgrades help to streamline surgery and to target more accurate outcomes, with greater patient convenience. The second thing the Verion does is use a surgical planner, which leads to more consistent surgery, Dr. Solomon said. "I usually put my incisions in a typical spot and plan my astigmatic incisions based on my surgically induced astigmatism. My plan is transferred to the LenSx Laser. The laser can execute the plan I need by placing the incisions exactly whether they need to be," he explained. The laser now also uses side- by-side imagery so surgeons can confirm they are operating on the exact location on or in the eye that was intended. If they aren't, the laser allows surgeons to adjust accordingly. "A lot of things done at the planning stage are snapped into place with side-by-side imagery," said Stephen Lane, MD, medical director, Associated Eye Care, and adjunct clinical professor, University of Minnesota, Minneapolis. The latest LenSx upgrade also transfers patient data wirelessly, avoiding transcription errors, Dr. Lane said. Victus Updates this year to the Victus Femtosecond Laser Platform (Bausch + Lomb, Bridgewater, N.J.) include Swept Source optical coherence tomography (OCT), which gives sur- geons a real-time view of what they are doing, said Robert J. Weinstock, MD, the Eye Institute of West Florida, Largo, Fla. The upgrade "improves the resolution of the OCT images and allows for live OCT images with a very fast refresh rate to be displayed during the docking, planning, and the laser treatment," Dr. Weinstock explained. This includes an OCT view of capsulorhexis formation, fragmen- tation, and bubbles formed and gas released in the nucleus. Surgeons can also watch their corneal inci- sions created live and get a sense of how dense a cataract is with the OCT technology. "It allows you to be confident with your laser treat- ments," Dr. Weinstock said. New software upgrades will identify the pupil edge and the anterior and posterior capsule, so surgeons do not have to mark these areas, Dr. Weinstock added. Femtosecond cataract laser upgrades Laser companies put more sophisticated plans into place M any cataract surgeons would agree that cat- aract surgery assisted with the femtosecond laser is a great way to boost efficiency and optimize outcomes. Yet as the technical capacities of the lasers evolve, there's room for improvement. The companies that make fem- tosecond cataract lasers continue to fine-tune their products, and this year is no exception. Here are the latest upgrades to a number of femtosecond cataract lasers, as reported by surgeons who are familiar with each laser and respective upgrade. LenSx The LenSx Laser's (Alcon, Fort Worth, Texas) incorporation of the Verion Image-Guided System makes surgical planning easier, said Kerry Solomon, MD, Carolina Eyecare Physicians, Charleston, S.C. "The Verion does 2 things. It measures the cornea and allows you to take an image-guided picture of the scleral vessels and iris landmarks that can account for cyclorotation," Dr. Solomon said. "That information is transferred to the laser, which helps orient the surgery in a precise and accurate fashion." The laser improvements facili- tate a faster procedure. "The whole treatment time has been cut in half. By the time I walk in the room and then leave, it can be 3 minutes or even under 2 minutes," he said. This year's Victus upgrade also includes new fragmentation pat- terns, so surgeons have more elabo- rate patterns available. "They allow for more aggressive pretreatment to soften the cataract," he said. Catalys Nearly all Catalys Precision Laser Systems (Abbott Medical Optics, Abbott Park, Ill.) now have the newest operating software, called COS3, and the latest Liquid Optics Interface 12, said Eric D. Donnenfeld, MD, clinical professor of ophthalmology, New York Univer- sity Medical Center, New York. The upgrade includes a redesigned user interface, streaming real-time OCT images that have enhanced confir- mation and incision control, and an enhanced Integral Guidance system that uses OCT to visualize ocular surfaces. "COS3 allows surgeons to make simple adjustments to the treatment plan, customizing to each patient," Dr. Donnenfeld said. As with other lasers incorporating real-time OCT, this allows better visualization of structures and cus- tomization of incisions, he added. The Liquid Optics Interface 12 docking system is the first laser cata- Overlay depicting the primary incisions, arcuate incisions, capsulotomy, and lens fragmentation pattern OCT image of the anatomy of the anterior segment with demarcation of the crystalline lens, iris, and cornea Source: Eric Donnenfeld, MD

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