Eyeworld

EW CATARACT 36 October 2015 by Gary N. Wörtz, MD changing culture, and today's pa- tients are aware of the advantages technology has to offer, and they have come to expect it. As a surgeon, LACS is what I recommend to my friends and family, and what I would opt for myself when the need arises. Surgical pearl For the cataract surgeon considering doing LACS, I recommend investing in a J cannula to perform hydrodis- section subincisionally immediately prior to cortex removal. This process loosens up the cortex adherent to the rim of the capsulorhexis. Once the subincisional cortex is loosened, you can easily remove it and then work around to remove the rest of the cortex. In my experience, the truncated cortex tends to adhere to the edge of the capsulorhexis. The J cannula eliminates any frustra- tion associated with this potential obstacle, thus making each step of the procedure as easy or easier than traditional cataract surgery. EW Editors' note: Dr. Wörtz is in private practice at Commonwealth Eye Surgery, Lexington, Ky. He has financial inter- ests with Abbott Medical Optics. Contact information Wörtz: garywortzmd@gmail.com Once the suction is complete, the bed swings under the laser for fine tuning and alignment with the laser. The majority of my dock- ing procedures are successfully completed in one attempt, an important component in patient perception. Patients constantly judge their doctor throughout the surgical experience, and many may experience anxiety when multiple docking attempts are required. When all aspects of the surgery flow smoothly, patients leave feeling confident that they made the right choice in selecting you as their surgeon. Tools help us work smarter Great technology in the hands of a great surgeon has the potential to give better results. Conversely, great technology in the hands of a bad surgeon still does not produce good results. Technology makes me a bet- ter surgeon; it makes the job easier. It is effortless and faster for the laser to make accurate arcuate incisions to treat astigmatism, to perform flawless capsulotomies, and to break up dense nuclei. I think it is important for this generation of surgeons to adapt to technology to ensure a place in the future. We live in a rapidly efficiency and produce a positive pa- tient experience. Using the Catalys system (Abbott Medical Optics, Ab- bott Park, Ill.), I recently performed 27 cases in a single day, 10 using a femto laser, and all without assis- tance. Compared to my early experi- ence with LACS, treatment times are shorter and easier. I attribute this to a variety of factors. • A fixed bed eliminates the time spent trying to get the patient's bed lined up with the laser. My practice workflow setup includes our own ambulatory surgical center (ASC), 2 operating rooms, and a third room containing the Catalys. We have found that having the patient get up out of the bed and move to the laser bed eliminates variances and addition- al time spent in setup caused by different bed models. The laser's preset positions are tailored to perform specific duties: getting the patient into the bed, applying the liquid interface optics ring, and performing the laser surgery. • A liquid optics interface design allows for gentle docking with minimal rise in intraocular pres- sure. A 2-part docking system al- lows for easier ring placement on the eye and gross alignment with the interface, away from the laser. One surgeon's perspective on laser-assisted cataract surgery L aser-assisted cataract surgery (LACS) is a powerful tool in the hands of the skilled surgeon. Just as the profes- sional golfer carries state-of- the-art technology in his golf bag to enhance his game, technology in the hands of the cataract surgeon creates efficiencies in the operating room while producing consistent, excellent outcomes. Evolution As an early adopter of LACS, I have witnessed LACS evolve from its infancy with rather cumbersome equipment and complicated soft- ware into streamlined systems offering patients the best option in safety and comfort for cataract surgery. Just 2 years ago, I could not make that statement. In my early days working on femto-phaco machines, the potential of inviting variability into my cataract cases was a concern, and as a surgeon, I prefer to keep my easy cases straightfor- ward. Early problems I encountered included incomplete capsulotomies. This created some frustrations as I then had to manually complete the capsulotomy in a less stable envi- ronment. Of further concern, my efficiency was hindered due to the amount of time it took me to set up and operate the laser to perform lens chops and fragmentation; prior to adopting the laser, I could manually perform the entire capsulotomy pro- cedure and remove the cataract in less time than it was taking me just to set up the laser. I simply was not convinced that LACS was ready to be embraced. However, new technol- ogy has addressed and resolved these concerns. Today, I can confidently say that LACS improves my efficien- cy and contributes to my success as a surgeon. Carefully consider design and workflow The latest generation of equipment quells the opinion that LACS is merely hype. In my experience, careful analysis of equipment design, features, and workflow setup contribute significantly to An important tool for the next generation of surgeons Dr. Wörtz performs LACS with the Catalys system. Source: Gary Wörtz, MD

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