Eyeworld

MAR 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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86 EW FEATURE February 2011 Refractive March 2012 The femtosecond choice by Enette Ngoei EyeWorld Contributing Editor Discussing the newly available option with patients N ow that you've decided to incorporate femtosecond cataract surgery into your practice, what's the best way to present this new option to your patients? EyeWorld talked to physicians in the U.S. and abroad who have worked it out. AT A GLANCE • "Rather than giving patients all the options of what they want, I tell them what I'm going to recommend for them based on what their vision needs are or what their vision choice is, and that seems to work incredibly well. So it's really a very short conversation" –Dr. Solomon • "We explain to patients that just like LASIK went through an evolu- tion from conventional LASIK to all-laser LASIK, this is the next evolution of cataract surgery" –Dr. Desai When his practice first incorpo- rated the LenSx Laser (Alcon, Fort Worth, Texas), Kerry D. Solomon, M.D., director, Carolina Eyecare Research Institute, Charleston, S.C., said he found it wasn't quite as simple a conversation as he thought it would be with patients. "It got confusing between I'm going to use a presbyopia-correcting lens, now would you also like a laser used," he explained. So he sat down with staff and educated them about the laser. To- gether, they reworked some of their patient education materials as well as how they talked to patients. Now, instead of talking about lens choices, laser versus ultrasound, and astigmatism versus no astigma- tism, the discussion has been reori- ented to focus on three options. "Rather than giving patients all the options of what they want, I tell them what I'm going to recommend for them based on what their vision needs are or what their vision choice is, and that seems to work incredibly well. So it's really a very short con- versation," Dr. Solomon said. In option one, patients get a standard monofocal lens that insur- ance provides and are fitted for Dr. Desai performs femtosecond cataract surgery Source: Neel Desai, M.D. glasses for all their daily activities. In option two, their vision is corrected for distance and they'll use glasses for reading. In option three, patients would be able to see both distance and near without being dependent on glasses. "If they're already successful monovi- sion patients, I tend to keep them in monovision and we'll treat their astigmatism—if it exists. If they have never done monovision and they are multifocal candidates, then I discuss Refractive predictability study by Robert J. Cionni, M.D., and Kerry D. Solomon, M.D. The purpose of the study was to compare refractive predictability of a monofo- cal IOL based on manual vs. laser refractive capsulotomy. This was a prospec- tive, non-randomized study that involved two sites. Patients undergoing uni- or bilateral routine phacoemulsification and implantation of the SN60WF lens (Alcon, Fort Worth, Texas) were included. A total of 83 eyes of 63 patients were included in the study. Eyes were assigned to undergo laser capsulotomy (n=44 eyes) or manual capsulotomy (n=39 eyes) with an intended size of 5.0 mm in both groups. Patients were evaluated pre-op, and accuracy to target and visual acuity were assessed 1 month after surgery. Mean age was 70±8 and 71±8 years in the laser and manual group, respectively. Sixty-nine percent were fe- males in the laser group and 57% in the manual group. No significant differ- ences were seen in the patients' demographics. The laser group had a mean average keratometry of 44.05±1.42 D (range 40.5-46.36), and the manual group was 44.27±1.80 D (range 40.40-47.30)(P=.536, –0.6212 t-value). Mean axial length was 23.60±1.01 mm (range 21.50-26.06) and 23.85±0.75 mm (range 22.67-25.25) in the laser and manual group, respectively (P=0.209, –1.2669 t-value). Figures 1 and 2 show the prediction error distribution per group, while Figure 3 summarizes the uncorrected visual acuity at 1 month after surgery. In summary, the laser group showed better accuracy to target refraction at 1 month post-op. Thirty-one percent more eyes were within 0.25 D of the intended target in the laser group compared to the manual group. Also, uncorrected visual acuity at 1 month was better in the laser group. Ongoing and future studies will include randomized study populations as well as larger samples and analysis across various IOL platforms. Editors' note: Drs. Cionni and Solomon have financial interests with Alcon. this option for their presbyopic needs. If they have astigmatism, we manage that in addition to the pres- byopia, in my case, typically with a femtosecond laser," Dr. Solomon said. Neel Desai, M.D., in private practice, Largo, Fla., said, "We ex- plain to patients that just like LASIK went through an evolution from conventional LASIK to all-laser LASIK, this is the next evolution in cataract surgery." Dr. Desai said his practice is ex- Source: Robert J. Cionni, M.D., and Kerry D. Solomon, M.D.

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