Eyeworld

World view Femtosecond laser cataract surgery innovations F emtosecond laser cataract surgery has decidedly entered the mainstream. My first laser cataract surgery was 4 and a half years ago, and there were only a handful of femtosecond lasers at that time. The procedure took close to 4 minutes, the capsulotomy was complete, but not free-floating, and the lens softening was minimal. Today we have seen logarithmic advances in femtosecond laser cataract surgery with improved astigmatic incisions and virtually 100% free-floating cap- sulotomies. Lens fragmentation has developed to the point that often there is no need for phacoemulsification energy in the great majority of cases. There are 4 different femtosecond lasers in the United States and a fifth laser waiting in the wings. Imaging and software advances have driven this remarkable disruptive technology. For many cata- ract surgeons the femtosecond laser has been the bridge to refractive cataract surgery by providing a safer, more reproducible arcuate incision for astigma- tism correction. In this issue of EyeWorld, we present a series of articles designed to improve the laser cataract experience from the perspective of economics, workflow, and surgical outcomes. We will hear about the latest advances in the Catalys, LENSAR, LenSx, and Victus, and where we are today. In addi- tion, we will take a peek into the future of these femtosecond lasers as the technology evolves. Cataract surgery is arguably the most successful surgical procedure in the world, but there is room for improvement. Growing up, my father had a favorite saying: "Be proud but never be satisfied." That is the beauty of oph- thalmology. We never settle for the status quo and are always looking for bet- ter answers for our patients. Cataract refractive results are not at the level of accuracy of LASIK, and there continues to be complications such as vitreous loss and endophthalmitis. This is the focal point of the role of the femtosec- ond laser. Can a new technology take us to better and safer outcomes for our patients? I believe the answer is yes. Early data suggest improved anterior capsulotomies, a better effective lens position, more precise and predictable refractive arcuate incisions, and less need for phaco energy. Ultimately, more data on overall safety and refractive precision are needed to warrant the additional time and expense of laser cataract surgery. Whether you perform cataract surgery with ultrasound or femtosecond energy, enjoy this issue of EyeWorld. EW Eric Donnenfeld, MD, chief medical editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S July 2015 Volume 20 • No. 7 Publisher Donald R. Long don@eyeworld.org Editorial Managing Editor Stacy Jablonski stacy@eyeworld.org Staff Writer Ellen Stodola ellen@eyeworld.org Staff Writer Lauren Lipuma lauren@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Vanessa Caceres Lakeland, Fla. Michelle Dalton Reading, Pa. Matt Young Malaysia Enette Ngoei Dublin Rich Daly Arlington, Va. Senior Contributing Writer Maxine Lipner Nyack, N.Y. 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