Eyeworld

discomfort, slows postoperative recovery, and increases the risk of complications. I think the best way to achieve this goal is to prevent inflammation from occurring at all, which is my personal goal. I offer femtosecond laser surgery to all of my patients with visually significant astig- matism or premium intraocular lens selections. In addition, I think new drug-delivery devic- es will be good adjuncts as we move forward. References 1. Data on file, Bausch + Lomb. 2. Takács AI, et al. Central corneal volume and endothelial cell count following Dr. Donnenfeld's perioperative inflammation regimen • Patient is pretreated with NSAID (bromfenac 0.07% or nepafenac 0.3%) QD for 3 days preoperatively and 1 month postoperatively. • Difluprednate 0.05% is administered ever y 15 minutes beginning 1 hour before surger y; it is prescribed BID for 2 weeks and QD for 1 week. • Intracameral phenylephrine/ketorolac is used for all patients during cataract surger y. • Femtosecond laser cataract surger y is offered to all patients with visually significant astigmatism and/or premium IOL selection. femtosecond laser-assisted refractive cataract surgery compared to convention- al phacoemulsification. J Refract Surg. 2012;28:387–391. 3. Nagy ZZ, et al. Macular morphology assessed by optical coherence tomography image segmentation after femtosecond la- ser-assisted and standard cataract surgery. J Cataract Refract Surg. 2012;38:941–946. Dr. Donnenfeld practices with Ophthalmic Consultants of Long Island and Connecticut, and is clinical professor of ophthalmology at New York University. He can be contacted at ericdonnenfeld@ gmail.com. Francis Mah, MD: I also think we will be using other deliv- ery systems within 5 years. We already have an approved agent with a nonsteroidal that is going into the eye. We also have agents that are on the doorstep, such as the punctal plug that is working through the approval process. Therefore, I think within 5 years, drops will be available for resistant cases or to treat cystoid macular edema, but I think our routine cases will be dropless. Eric Donnenfeld, MD: Econom- ic and compliance issues are changing pharmaceutical deliv- ery at a pace I have never seen in ophthalmology, so I think the transition to dropless procedures will occur rapidly. Corticoste- roids may be used intracamer- ally to treat inflammation and topically to optimize the ocular surface. However, I think non- steroidals and antibiotics will be used inside the eye, without a doubt. Dr. Lindstrom: In your prac- tice, what percentage of your cataract surgeries are performed with femtosecond laser-assisted cataract surgery (LACS)? In ad- dition, looking ahead 5 years to other innovative alternatives to perform capsulotomies and frag- ment lenses, will LACS continue to grow in your practice, or do you think it will be challenged? Dr. Kim: I've been surprised at the successful integration of LACS into my practice and the patient acceptance of this technology. Approximately 70% of my cataract surgeries are performed with the femto- second laser. Patients typically like the concept of a laser and understand the connotations of precision and safety. Therefore, it has been very easy to adopt and discuss with patients. I think it is here to stay, and adoption will certainly continue to increase during the next 5 years. Dr. Holland: We are the largest group in the U.S., and we have many high-volume cataract surgeons, but we do not have a femtosecond laser. I think that will change in the future. I think we would like to see innovation in which all of the technology is in the operating room on the op- erating microscope so we do not need to switch rooms or devices. I think this technology will contin- ue to improve, and I am sure we will be using it. Dr. Mah: We just adopted the femtosecond laser in October. I am using it in approximately 20% of my cataract patients, but that is growing quickly. I am using 40% premium IOLs; I am sure that number will continue to grow, probably to roughly 70%. Dr. Donnenfeld: I use the fem- tosecond laser in 70% of cataract surgeries in our practice. I think it will continue to grow. Charles Kelman, MD, said it best: "Doc- tors debate; patients decide." In my practice, patients have decid- ed this is what they want. I think the results justify it, and it is certainly something I would want a surgeon to perform on my eyes. Richard Lindstrom, MD: In your opinion, in 5 years, which of the 3 medications we currently use (antibiotic, steroid, and nonste- roidal) will be delivered with a method other than drops? Edward Holland, MD: All of them. I think physicians and patients want other drug-delivery systems. Several medications are under evaluation. I think in 5 years all of them will be delivered into the eye, and patients will not be using drops after surgery. Terry Kim, MD: With ongoing innovations, we are looking at punctal plug-delivery systems, depots that will be placed in the eye, and intraoperative use of medications. Many surgeons have discussed the frustrations associated with topical medi- cations: cost, compliance, and callbacks. We need to reduce these because they drain our time and resources. I think these inno- vations will make surgeons and patients happier. Panel discussion Supported by Alcon Laboratories, Bausch + Lomb, Imprimis Pharmaceuticals, Ocular Therapeutix, and Omeros Corporation 7

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