Eyeworld

49 EW FEATURE July 2015 Femto cataract clinical update added that those who are insured will usually be reimbursed by their healthcare providers. Advantages and disadvantages Dr. Cummings said that the liter- ature on femto is not yet showing that it's better than phaco. Patients like the idea that femto can make a repeatable capsulorhexis every time, he said, but they really care about how they will see compared to someone who had regular phaco. "The benefits don't currently justify getting the device when it means the patient is going to pay for the entire procedure rather than just for the copay," he said. "But there's no question that in time it will be the way it's done." He believes that it will make sense to use the femtosecond laser when there are lenses specifically made for femto and for a perfect rhexis. The femtosecond laser gives better positioning of the capsulor- hexis and softens the lens, he said. "I personally think it will take off when lenses come onto the market that have been designed specifically for femto phaco." The advantages of the femtosec- ond laser are well documented, Dr. Yeoh said, including rounder and more precise capsulorhexes, lower ultrasound energy usage, and more consistent incisions. "These, how- ever, have not translated to more precise refractive outcomes," he said. "Most surgeons agree that while the jury is still out on the refractive benefits of FLACS for 'standard cat- aracts,' the advantages in complex cataracts like dense nuclei, subluxat- ed lenses, fibrotic cataracts, and pos- terior polar cataracts are obvious." Apart from the cost of the procedure, the only other issues that may be faced are the greater length of time for surgery and greater space requirement, Dr. Yeoh said. New surgeons will also need to modify their surgical technique. "It's my firm belief that if cost was not an issue, many surgeons would take up FLACS," he said. Dr. Lawless thinks that the major advantage of FLACS is that it is safer. "The capsulotomies with current technology and techniques are round, centered, and robust," he said. "My anterior capsular tear rate compares favorably to manual sur- gery, and I have published on this." Additionally, the nuclear fragmenta- tion means the time inside the eye with phacoemulsification is less, and less energy is used with less manip- ulation. Corneal incisions are the least useful part of the technology, Dr. Lawless said, but he performs them routinely, occasionally opening them with a blade. "The safety that is conferred by the capsulotomy and lens fragmentation is obvious to a surgeon who uses this technology frequently," he said. "The only dis- advantage is cost to the patient." Changing technique Dr. Lawless said that the femtosec- ond laser has changed his phaco technique. "I was always a prechop- per in the Akahoshi mode prior to femtosecond surgery, and I still prechop, but these days with a blunt prechopper," he said. "I am a person who likes a stable anterior chamber, so I am lucky that I have the Centurion system [Alcon] to allow me to achieve this." Dr. Lawless added that he has slightly modified his cortical aspiration to remove the cortex in a more peripheral fashion. He finds this to be quick and efficient. "Overall, the femtosecond laser has led to less intraocular trau- ma and quieter, more comfortable eyes," he said. "I no longer use the astigmatic incisions with the femto laser, preferring instead to use toric IOLs down to low levels of astigma- tism as they are more predictable than even a laser incision can be." Dr. Yeoh uses the femto pre- chopper to complete nucleus separation in most cases of femto- fragmented nuclei. "Since getting comfortable with using the femto prechopper, I am now using a regu- lar prechopper for nuclear division in many of my routine non-FLACS softer cataracts," he said. Additional- ly, a greater appreciation of a round and well-positioned femto CCC has led him to try harder to achieve the same with the manual CCC tech- nique. EW Editors' note: Dr. Cummings has financial interests with Alcon. Dr. Yeoh 2500 Sandersville Rd., Lexington, KY 40511 USA Phone: 800-354-7848, 859-259-4924 Fax: 859-259-4926 E-Mail: sales@stephensinst.com www.stephensinst.com Femtosecond Laser Cataract Surgery Instruments S5-1535 LRI Enhancement Forceps Cross-action provides accurate spreading of incisions pre- or post-operatively, or during slit-lamp examinations. S4-1700 Femtosecond Spatula Double ended sizing and spear shaped, thin blunted tips offer versatility for opening primary and secondary femtosecond laser incisions. S4-1710 Femtosecond Chopper Special design chops femtosecond laser fragmented nuclei with its unique shaped tip. has financial interests with Alcon (Fort Worth, Texas), AMO (Abbott Park, Ill.), and Bausch + Lomb (Bridgewater, N.J.) Dr. Lawless has no financial interests related to the article. Contact information Cummings: abc@wellingtoneyeclinic.com Lawless: Michael.lawless@visioneyeinstitute.com.au Yeoh: ersryeoh@gmail.com

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