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53 EW FEATURE July 2015 Femto cataract clinical update Dr. Perry was skeptical to begin with because he didn't see the need for the technology. Because cata- ract surgery is already a successful surgery, he did not see the value that the femtosecond laser would create for the everyday practice. However, as one member of the surgery center, he was outvoted, and the practice acquired a LenSx laser (Alcon, Fort Worth, Texas). During the first week with the new laser, Dr. Perry said that 2 of the best surgeons in the 50-surgeon practice both lost nuclei on "not difficult" cases. This caused him to think even more about the issues with the laser, but he realized that there would naturally be some problems during the initial introduc- However, he noted that in his first 40–50 cases, the capsulorhexis was not complete, so he had to go in manually and make sure there were no edges. A later software correc- tion helped to fix this and make the openings more consistent. After switching machines to a Catalys laser (Abbott Medical Optics, Abbott Park, Ill.), Dr. Perry really got on board because he said the machine had very few problems. He compiled his surgical outcomes and incidence of complications in his first 152 cases with the LenSx and Catalys and only had 2 complica- tions. "I compared this to what I had been doing, and I felt that there was a significant difference," he said. "I think it's one of those things that makes good surgeons better, and I think it makes average sur- geons better," Dr. Lewis said. The femtosecond laser can help enhance results, and he believes the data is beginning to show more and more that there is improved safety with this technology. How has femto changed your practice? Patients like new technology, Dr. Lewis said. "They want to go to the person with the latest technology." So the femtosecond laser helps to create a positive buzz in the practice. Over the past 3 years of using the femtosecond laser, Dr. Perry said he feels it's safer than doing a manual capsulorhexis because it's done in 1.3 seconds under suction. It makes sense that it's superior to doing a manual capsulorhexis that may take 20 seconds or longer and has more opportunity for error, he said. "I tell the exact same thing to my patients," he said. "I feel it's a safer procedure and I have better success with it." Dr. Perry said that another aspect that helps with the ease of femtosecond laser surgery is having someone to operate the laser. In his practice, a fellow does this, and it helps improve the surgical flow, he said. How to talk to patients about it Dr. Lewis said that if a patient comes in for cataract surgery, he or she will get information on the femtosecond laser and other options. Technicians do a complete exam, and while the patient is dilating, he or she watches a video of different options, including laser options for treating astigmatism. Dr. Lewis is using the femtosecond laser on about 20% of his cataract patients now. EW Editors' note: Drs. Lewis and Perry have no financial interests related to this article. Contact information Lewis: rlewiseyemd@icloud.com Perry: hankcornea@gmail.com EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send an online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the hundreds of physicians who take a minute a month to share their views, please send us an email and we will add your name. Email carly@eyeworld.org and put EW Pulse in the subject line. Poll size: 229 tion of new technology and that he should at least give it a chance. What changed your mind? When Dr. Perry first began using the femtosecond laser, he started doing relaxing incisions on corneal transplant patients to become more familiar with the instrument. "I saw that you could do superb relaxing incisions with it," he said. The laser could go right inside the graft margins, and it was programmable to 80% depth. Then he started using the laser for patients who had high astigmatism. Dr. Perry's first case with the LenSx was a divide and conquer that he programmed into the machine. " I think everyone feels like whatever they're doing is the best thing and the right thing, and we're always reluctant to incorporate new technology. There's always a hesitation of 'Do I need it and is it worth the price?' " –Richard Lewis, MD

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