Eyeworld

EW FEATURE 44 Femto cataract clinical update July 2015 by Lauren Lipuma EyeWorld Staff Writer AT A GLANCE • The goal of laser cataract surgery is to achieve predictability, safety, and refractive outcomes similar to those currently attained with refractive surgery. • The economics of laser surgery are an issue for many surgeons, but patients have quickly embraced the technology. • Many surgeons have adopted laser cataract surgery more quickly than they adopted phacoemulsification. "It makes surgery easier and more predictable for, if not every cataract surgeon, the majority of us," he said. "Whether it's a young patient with elastic tissues, a very hard nucleus, or a patient with compromised zonules from a genetic condition like pseudoexfoliation, the laser really shines in making the difficult cases routine and the impossible cases possible." The initial challenges The early days of laser cataract surgery were filled with issues that needed to be worked out, from increasing the accuracy of the laser cuts and OCT image quality to optimizing the software and patient interface. Dr. Slade recalls the early days of using the laser as times of trial, error, and modification—making small changes to the software, patient interface, and OCT after each case until the laser cuts were just right. Initially, the capsulotomy and fragmentation went well, but corneal cuts were more central than expected based on the OCT and surgical screen images, causing more surgically induced astigmatism (SIA) than anticipated, Dr. Nagy said. In all surgeries, the less you do, the better it is for the patient, he said, and laser cataract surgery allows him to spend less time inside the eye, using fewer instruments and less fluid. "I think it provides surgery that is more elegant and a gentler surgery for the patient," he said. "Some people say that it makes the surgery easier, and it can, but in no way do I think it's a crutch for lesser sur- geons. I think it's made me a better surgeon." "I felt the same excitement performing the first capsulotomy and fragmentation as I did when I started refractive surgery in 1992," Dr. Nagy said. "The aim of femto laser-assisted cataract surgery is to achieve predictability and safety results similar to those we have achieved already in refractive sur- gery. This technology is not replac- ing good surgeons, it is helping good surgeons to achieve even better refractive results." Jonathan Talamo, MD, direc- tor, Massachusetts Eye and Ear In- firmary Waltham, Waltham, Mass., believes the biggest benefit of laser cataract surgery is that it provides consistent and predictable results. Advances in laser technology and changing physician attitudes have fueled the growth of this premium procedure O ver the past 50 years, phy- sicians have found ways to use lasers in almost every area of ophthalmology— from repairing tears in the retina to creating corneal flaps and treating glaucoma. Using lasers in cataract surgery seems a natural step, but for a laser to supplement The evolution of laser cataract surgery or replace such a successful manual procedure, the technology has to be just right—and so does the timing. Now, for laser cataract surgery, it seems that these criteria are close to being met. Since the first laser-assist- ed cataract procedure was performed 7 years ago, the technology has evolved dramatically, patients have embraced it, and more physicians than ever are adopting it. Here, 4 laser cataract surgery pioneers share their experiences watching this procedure evolve—their triumphs, challenges, and views on where laser cataract surgery will go in the future. Recognizing the laser's potential Zoltan Nagy, MD, clinical profes- sor of ophthalmology, Semmelweis University, Budapest, Hungary, performed the first laser cataract pro- cedure in the world, and Stephen G. Slade, MD, Slade & Baker Vision Center and Laser Center of Houston, performed the first procedure in the U.S. Both surgeons immediately rec- ognized that the femtosecond laser had the potential to transform cat- aract surgery. "This one just seemed to make total sense to me," Dr. Slade said. "It seemed to be a great way to use the laser." Laser cataract surgery: A timeline 1991 IntraLase (Irvine, Calif.) introduces the femtosecond laser for LASIK flap creation 2001 IntraLase founders form LenSx Lasers (Aliso Viejo, Calif.), the first company to produce a femtosecond laser for cataract surgery January 2008 Zoltan Nagy, MD, performs the first laser cataract procedure at Semmelweiss University, Budapest, using a prototype LenSx laser August 2008 LenSx laser platform receives U.S. Food and Drug Administration (FDA) approval August 2009 Harvey Uy, MD, Mataki City, Philippines, performs the first laser cataract procedure in Asia December 2009 Jack Dodick, MD, and Jens Christiansen explore the use of Nd:YAG lasers in breaking up cataracts, coining the term "Nd:YAG phacolysis"

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