Eyeworld

EW NEWS & OPINION 46 April 2016 hydrodissection," she said. You want to get some of those air bubbles out. Pearl 8 was for easy cleavage but difficult capture. The laser cuts minimize the need for grooves and ease the splitting of the segments. "Cleavage is very easy, but it's im- portant to know that these are tight spaces," Dr. Shamie added. Next, Dr. Shamie said that you "may need 2 hands to tackle the cor- tex." Her final pearl was to consider delaying LRI management. EW Editors' note: Dr. Shamie has financial interests with Abbott Medical Optics (Abbott Park, Illinois), Allergan (Dublin), Bausch + Lomb (Bridgewater, New Jersey), Shire (Lexington, Massachusetts), and Nicox (Sophia Antipolis, France). Contact information Shamie: nshamie@yahoo.com ensure centration and that there is no lens tilt. Using images on the screen can help make sure the treat- ment zone has enough space to the capsule. Pearl 5 was that you're "not married to those incisions," Dr. Shamie said. One of the benefits is that if you don't open the inci- sion, it seals back down. Also, if the incision is placed too centrally, don't operate through that incision, she said. Dr. Shamie's sixth pearl was to assume there are capsular tags. The question is how fragile those tags are and how easily you can disrupt them. "Ensure a complete capsuloto- my before removing the cap." The next pearl was to first burp and then wave. Soften the chamber, Dr. Shamie said. "Air bubbles can get trapped behind the lens, so you don't want to be too aggressive in by Ellen Stodola EyeWorld Senior Staff Writer when they get to the operating room. "But with the laser, because we're still in the learning phase, we need to think about this and antici- pate problems a bit more," she said. Scars can impede laser applications and can cause capsular problems. The grading of the density of the lens is important to do at the slit lamp. "That's where you can get a better sense of what the lens density is and decide on the type of cut you're hoping to perform," she said. Pearl 3 was that operative planning is critical. "Set the right expectations," Dr. Shamie said. The patient needs to know that you may have to convert to traditional phaco and that you may not be able to use the laser. The fourth pearl related to dock- ing the laser. "The patient needs to be flat on the table," she said. "There needs to be minimal tolerance for moving." She said it's important to N eda Shamie, MD, Los An- geles, presented her top 10 pearls for transitioning to femtosecond laser-assisted cataract surgery during a session at the 2016 Hawaiian Eye meeting. Pearl 1 is you need to know your tools. "You need to know the strengths and weaknesses of your tools," she said. There are 4 femtosecond platforms available, and Dr. Shamie has operated on 3 of them. All of the platforms have "wonderful strengths," she said. It's helpful to have access to multiple laser platforms because this allows for customization of the procedure to different patients' needs. Her second pearl was to expand preoperative considerations. When surgeons are performing cataract surgery in the traditional way, they may become confident that they'll be able to deal with certain issues 10 pearls for transitioning to femtosecond laser-assisted cataract surgery Presentation spotlight

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