Eyeworld

Supported by unrestricted educational grants from Alcon Laboratories, Bausch + Lomb, LENSAR, and Sightpath Medical 3 Making femtosecond laser-assisted cataract surgery work in your practice In their ASC, surgeons need to understand the financial impact of performing LACS and develop a business plan to be financially successful. In addition, clinicians need to educate their ASC staff. They should develop a flow and have a traffic coordinator. Staff should develop a rhythm and modify procedures accordingly. Conclusion Advances in femtosecond laser technology offer numerous ben- efits for surgeons interested in integrating laser-assisted cataract surgery into their practices. Sur- geons who are exploring this tech- nology need to understand the benefits and take steps to ensure a successful launch. Reference 1. Abell RG, Kerr NM, Howie AR, Mustaffa Kamal MA, Allen PL, Vote BJ. Effect of femtosecond laser-assisted cataract surgery on the corneal endothelium. J Cataract Surg. 2014;40:1777–1783. Dr. Solomon can be contacted at kerrysolomon@me.com, and Dr. Donnenfeld can be contacted at eric- donnenfeld@gmail.com. F emtosecond laser tech- nology has advanced significantly during the last several years. Sur- geons who are exploring laser-assisted cataract surgery (LACS) need to weigh its poten- tial benefits and consider the best strategies to incorporate it into their practices. Determining advantages The femtosecond laser increases precision in some aspects of cataract surgery, said Kerry Solomon, MD, director, Car- olina Eye Research Institute, and adjunct clinical professor of ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, who presented with Eric Donnenfeld, MD, Ophthalmic Consultants of Long Island and Connecticut, and clinical professor of ophthalmol- ogy, New York University, during the 2015 ASCRS•ASOA Sympo- sium & Congress. They reported that the automated technology performs capsulotomies more precisely, pre-softens and pre-segments the lens and reduces ultrasound energy, creates arcuate incisions to correct astigmatism (with an option for intrastromal incisions), and creates cataract incisions with a 3D architecture for greater seal- ability and reproducibility. The femtosecond laser is particularly important in creating arcuate incisions. "If we're going to become refractive cataract surgeons and meet the needs of our patients to produce excellent, uncorrected visual acuity, we have to be able to perform astigmatic incisions," Dr. Donnenfeld said. In addition, a number of studies have shown less endothe- lial cell loss with femtosecond laser procedures, Dr. Solomon said. 1 "One of the real benefits of the laser is using high-definition optical coherence tomography," Dr. Solomon said. "You can pre- cisely measure real time the thick- ness and depth. You can image the cornea. Then you can very precisely determine the depth and the actual length of the arcuate incisions, and those provide for better, more accurate outcomes." "In addition, we're all accus- tomed to doing limbal relaxing incisions, while intrastromal incisions, I believe, will become the mainstream," Dr. Donnenfeld said. He explained that intrastro- mal incisions reduce pain and the risk of infection and offer better astigmatic predictability; how- ever, they cannot be performed manually. Incorporating LACS Seven of 10 cataract patients have astigmatism that can be treated with toric intraocular lenses, arcuate incisions, limbal relaxing incisions, or other techniques, but it is treated in only 15% of cases, Dr. Solomon said. "Eighty- five percent of your patients are interested in being less dependent on glasses," he said. "These are conversations you need to have, and femtosecond lasers are a way to make that happen." They offered pearls for in- tegrating LACS into a practice or ambulatory surgery center (ASC) (Figure 1). If integrating the technology, surgeons must believe LACS is good for patients and demonstrate their commitment to their staff and partners. "If they sense that from you, they're more likely to adopt it and pass that along to the patients," Dr. Solomon said. The practice should provide educational materials to patients. However, physicians should avoid overselling the procedure. "I never pressure patients to feel like they are having something suboptimal if they are going with phacoemul- sification alone," Dr. Donnenfeld said. Surgeons may offer refractive packages including non-covered services that are not part of the routine practice, Dr. Solomon said. Furthermore, clinicians should prepare to manage en- hancements themselves or refer patients to a partner or colleague for enhancements, Dr. Solomon said. Eric Donnenfeld, MD Kerry Solomon, MD Figure 1. Pearls for integrating LACS into a practice or ASC Source: Eric Donnenfeld, MD, and Kerry Solomon, MD • Success pearls for your practice 5. Be committed 4. Educate staff and partners 3. Provide education materials 2. Don't oversell—educate your patient 1. Consider refractive packages • Success pearls in your ASC 5. Understand the financials 4. Educate ASC staff 3. Develop a flow 2. Have a traffic cop 1. Be efficient with the procedure

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