Eyeworld

EW CATARACT 29 Dr. Scott said he thinks the laser provides safer outcomes and could also extend the careers of some baby boomer surgeons. Based on research from his practice, which will be published in the Journal of Cataract & Refractive Surgery, 1 Dr. Scott said there was a statistically significant decrease in the practice's rate of vitreous loss complications after adopting the femtosecond laser. One surgeon near the age of retirement who had what Dr. Scott called a higher vitreous loss rate that was still within the acceptable range saw a decrease after starting to do FLACS. "In the United States, this is a significant factor because the ser- vices needed are going to be increas- ing and at the same time we have a lot of doctors in that age group who are either going to try to continue to work or retire. The difference of when they do that is going to have a significant effect on access to care," Dr. Scott said. One final piece of advice Dr. Scott offered those just starting with FLACS is to choose routine cases. "My first patient was 89 years old with a grade 3–4 lens and I was determined to do it with no [pha- co] energy. That's not the mindset you want. Pick your routine, grade 2–3 cataract with normal health in eyes. … And don't worry about how much phaco energy you're using initially. Eventually you will be- come more efficient with fracturing the lens and getting the pieces in a position where you can just aspirate them." EW Reference 1. Scott WJ, et al. Comparison of vitreous loss rates between manual phacoemulsification and femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2016;42. Article in press. Editors' note: Drs. Waring and Scott have financial interests with Abbott Medical Optics. Contact information Scott: Wendell.Scott@Mercy.Net Waring: georgewaring@me.com and forth. This is something that you want to prepare in advance be- cause it requires the whole OR team to anticipate." Dr. Scott said his practice decided to invest in two lasers that are now present in each operating room. "We wanted a system where we could continue to do an efficient and high volume of surgery," he said. Though this was a large capital investment and took some addi- tional time initially, Dr. Scott said the ability to use the laser intraop- eratively, swinging the patient from the microscope to the laser and vice versa as needed, has been a benefit. Why some make the move Nuclear disassembly is one of the main benefits of femto, Dr. Waring said. "It allows you to customize for the patient's lens density. For example, in someone with a mature cataract, we will preset the laser for a smaller cube design. We generally do a cruciate chop design on all pa- tients and then use additional cubed quadrants with smaller cubes for the denser lens," he said. For dysfunctional lens cases and routine phaco cases, he uses a technique he calls "femto pre-chop." The pre-slicing allows for a fluid and seamless quadrant removal, in Dr. Waring's opinion. What's more, he said the laser allows surgeons to customize the diameter of the capsulotomy, which he noted will be perfectly round with sound structural integrity. Dr. Waring said a routine capsule diam- eter is 4.9 for dysfunctional lenses and 5.0 mm for routine cataracts, but when it comes to an intumes- cent cataract or a more complex case, he may increase to a diameter of 5.1. In addition, the laser offers the opportunity for bladeless astigma- tism correction or reduction at the time of surgery. "We think that there is an increasing body of evidence that femto arcuates may prove to lead to superior refractive out- comes," Dr. Waring said. 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