Eyeworld

147 EW MEETING REPORTER achieve is a continuous curvilinear capsulorhexis," Dr. Hengerer said. The femtosecond laser offers a high probability of being able to create this completely circular shape. Femto in difficult cases With FLACS still catching on, many surgeons are still deciding when to use the technology. However, in addition to aiding in making a "per- fect" capsulorhexis and other aspects of traditional cataract surgery, it may progressive corneal edema—as an accelerating aging of the cornea. Corneal endothelial cells don't divide after birth, so their DNA accumulates the damage from UV light exposure and oxidation over a person's lifetime. Dr. Jurkunas's research has shown that intracellular ROS are involved in the destruction of corneal endothelial cells and the formation of guttata in Fuchs' dystrophy, making it an oxidative stress disorder—not unlike macular degeneration. "Are guttata the drusen of the cornea, or are drusen the guttata of the retina?" she asked. Just as cor- neal endothelial cells are among the oldest cells in the body, lens crystal- lins are among the body's oldest pro- teins. Adrian Glasser, MD, Houston, explained how protein turnover—a process that ensures a constant supply of functional proteins—can- not happen in the lens because it is constrained within the capsule and has no blood supply. As a result, lens crystallin proteins degrade over time, eventually losing their elastic- ity and transparency—causing both presbyopia and cataract formation. "What's happening is we're outliving the life expectancy of our lenses," Dr. Glasser said. The fact that these ocular diseases are disorders of aging could impact the delivery of healthcare worldwide, said Norbert Pfeiffer, MD, Mainz, Germany. Although the burden of many diseases will go down, as the population ages, the burden of eye diseases will go up, and clinicians must stress this to other physicians, lawmakers, insurance companies, and industry, he said. Basic science of the femtosecond laser The femtosecond laser offers a number of advantages for surgeons adopting the technology. In a session devoted entirely to femto- second laser-assisted cataract surgery (FLACS), Fritz Hengerer, MD, Frank- furt, Germany, highlighted some of the basic science aspects involved with the femtosecond laser, focusing primarily on corneal incisions and the capsulotomy. Looking at corneal incisions, one of the main items of femtosec- ond laser technology is surgeons can guide these incisions according to OCT measurements, he said. When looking at the size and architecture of the main incisions, there is the possibility of doing multi-planar incisions more precisely than with manual technologies. In terms of the capsulotomy, the goal is to obtain the "perfect" shape and size. "What we always want to have applications in challenging cas- es. Jose Güell, MD, PhD, Barcelona, spoke to attendees about which diffi- cult cases he thinks might be best treated with the femtosecond laser. "Most surgeons are still using FLACS only in standard cases," Dr. Güell said. However, many are start- ing to explore the applications for difficult situations. Currently, most Innovation and craftsmanship that helps you rise above. FAMOUS FOR SEEING WHAT OTHERS CAN'T. Haag-Streit vision spans more than 150 years. Our goal is simple: to develop ever more useful tools for the precise understanding of the human eye. At Haag-Streit, you will see the future clearly. See us at AAO, booth #3815. The Superior Practice. 80O.787.5426 haag-streit-usa.com © 2015 Haag-Streit USA. All Rights Reserved. Reliance FX920 /7900IC Octopus 600 Reliance XOMA LENSTAR Haag-Streit Surgical Hi-R NEO 900 Haag-Streit BQ 900 LED continued on page 148 October 2015

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