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Reporting from the Date AAAA City, Country EW MEETING REPORTER 166 April 2016 This is a novel technology that provides image-guided laser cataract surgery, Dr. Donnenfeld said. It pro- vides precise capsulotomies, which can be optimized for improved refractive results. This technology also helps reduce phacoemulsifica- tion time and energy. There will be new IOL designs coming, and in the future, Dr. Donnenfeld thinks the femtosecond laser will play an even more prominent role than it does today in cataract surgery. Tal Raviv, MD, New York, spoke about integrating femtosecond cat- aract surgery into a practice, and he shared 4 factors that need to change to effectively integrate femto: in- formed consent, billing compliance, refractive packages, and surgical patient flow. Informed consent is not that different, Dr. Raviv said. The sur- geon should have a discussion with the patient about the benefits and the risks of the procedure. It's also important to add a femto addendum to your cataract surgery consent, he said. Billing compliance involves es- tablishing guidelines for billing the use of the femtosecond laser. When offering refractive packages, it may help to have the use of the femtosec- ond laser already incorporated into refractive IOL packages that patients may select. Patient flow is also important. This could involve a different room setup to consider the machine's presence. Choosing to use the fem- tosecond laser in the OR or outside the OR can have different advantag- es and disadvantages. Editors' note: Dr. Donnenfeld has financial interests with different fem- tosecond laser companies, but none directly related to his comments. Dr. Raviv has financial interests with Abbott Medical Optics and Alcon. Glaucoma procedures: "We don't have to fear it anymore" "The world is changing when we think about MIGS," said Robert Noecker, MD, Fairfield, Connecticut. While surgical management of glaucoma up until a few years With the white lenses, Dr. Ayres said that oftentimes surgeons may start to make the capsulorhexis, but then it extends out causing an Argentinian flag sign. The way to fix this, he said, is to first decom- press the capsular bag. But Dr. Ayres cautioned attendees that when aspirating to make sure they are aspirating the lens material and not viscoelastic. For a brown lens, Dr. Ayres said a large capsulorhexis helps with chopping the lens. He recommend- ed sculpting a deep crater in the lens and using a horizontal or vertical chop. Make sure the posterior plate separates, he said. Dr. Ayres said that using a laser may help with some of these diffi- cult lenses, but he added that there are still some cataracts that "laugh" at the power of the laser. Be careful making the capsulor- hexis in these hypermature lenses, Dr. Ayres said. Decompress and be creative if needed, he said. Sculpt and imbed deeply, and be patient and ready for potential complica- tions, Dr. Ayres said. Editors' note: Drs. Ayres, Koplin, and Park have no financial interests related to their comments. Femtosecond cataract surgery Eric Donnenfeld, MD, Rockville Centre, New York, gave attendees an overview of femtosecond laser cataract surgery, highlighting the history, technologies available, and some of the advantages and disad- vantages of the technology. There are a number of femtosecond tech- nologies out there, and they all work well, he said. Some of the advantages include improvement to lens fragmentation and an improved capsulotomy. There are also some complica- tions that can occur with the fem- tosecond laser, like more frequent subconjunctival hemorrhages. Pupil constriction can be a real problem, Dr. Donnenfeld said, as can retained nuclear fragments. Incomplete cap- sulotomy was an issue in the early days of femto, but he said that's now infrequent. SAVE $ MTI's products are perfect for the Ophthal- mologist looking to enhance their practice. Our chairs include the 421, 423, 424, 430 and 440 models. The 440 Mobile Quad Battery Powered Stretcher Bed provides safe transport from pre-op to recovery, ultra-thin backrest, 2 smart-lithium ion batteries, 3.5 hour charger, memory foam cushions, precision casters, stor- able steering handles, dual headrest locks, 6" headrest extensions, 4 programmable positions and limitless add-on accessories. 888-507-1389 mti.net/ophthalmology

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