EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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28 EW CATARACT Laser continued from page 26 OptiMedica Interface design Imaging type Ocular surface identification Integrated chair System dimen- sions (w/o bed) System origin Liquid optics (immersion lens) 3D spectral domain OCT Automatic or user-adjustable Yes 35 x 65" Laser cataract surgery Alcon LenSx Curved lens 3D OCT Manual No 48 x 62" Femtosecond LASIK (Intralase) LensAR Robocone (immersion lens) 3D-CSI (confocal structured illumination) Automatic No Technolas/ B+L Curved lens Online OCT Manual Yes 78 x 36" (extended) 41 x 81" Presbyopia treatment Table 1. Key system figures for the femtosecond lasers for refractive cataract surgery Mark Packer, M.D., clinical as- sociate professor, Oregon Health & Sciences University, Portland, Ore., found that when the LensAR lens fragmentation was used in 225 eyes, there was no loss of endothelial cells, while 63 eyes that received standard treatment had cell loss of Outside temperatures, sun exposure, gender may trigger exfoliation syndrome A ge, gender, and location influence a patient's risk of developing ex- foliation syndrome (ES), which leads to an increased risk for cataract and cataract surgery complications and is a leading cause of secondary open-angle glaucoma. "Although many studies from around the world have reported on the burden of the disease, some aspects of the basic descriptive epidemiologic features, which may help shed light on the cause, are inconsistent," said Louis Pasquale, M.D., study co-author, and director, Glaucoma Center of Excellence, Massachusetts Eye and Ear Infirmary, Boston, in a press release. "In this study we found that women are more vulnerable to this disease than men, that ES is not a disease of Norwegian descent, and that where you live does matter when it comes to developing the disease." "Importantly, those with a lifetime residential history of living in the middle tier and south tier of the United States was associated with 47% and 75% reduced risks, respectively, compared with living in the northern tier, and across the life span, residence at age 15 was the most strongly associated with risk, followed by current residence," the authors wrote. Researchers also found that iris color did not seem to be a risk factor, but a positive family history of glaucoma was associated with a more than doubling of risk. "This large prospective cohort study demonstrates that there is a positive association between latitude and ES risk that is robust and not related to demographic features or other systemic covariates," Dr. Pasquale explained. "Another manuscript we published recently suggests that lower ambient temperature interacts with increased solar exposure to increase the risk of ES. This new work demonstrates a relation between increasing latitude and a condition with a strong predisposition to glau- coma. More work is needed to determine how environmental factors conspire to contribute to ES." Femtosecond LASIK Source: Jonathan H. Talamo, M.D. 1-7%. Differences were statistically significant at the 90% level for grades 1 and 3, but not grades 2 and 4, he said. LenSx Jorge L. Alio, M.D., professor and chair of ophthalmology, Miguel Hernandez University, Alicante, Spain, described his technique of sub-1 mm incisions, a process he dubbed "Femto-MICS." A prospec- tive study evaluated the repro- ducibility and refractive impact of corneal incisions made with the LenSx for both standard and micro- incisional surgery; the incision width was between 1 and 1.3 mm, with follow-up at 1 month. "The incisions are always self- sealing and induce no refractive astigmatic change," he said. His group found "the best optical profile is obtained with two 1-mm inci- sions, orthogonal, with a third inci- sion at 1.8 mm" (opened for the purpose of IOL implantation). Zoltan Nagy, M.D., clinical professor of ophthalmology, Semmelweis University, Budapest, Hungary, found a laser two-plane incision (n=42) does not require stromal hydration, but a manual in- cision (n=43) needs stromal hydra- tion 90% of the time. Globally comparing the 6,000+ procedures performed with the LenSx, more pa- tients reached 20/20 earlier in the post-op period with the laser than through manual techniques. The laser is "more predictable at month 1 with a 78% reduction in pre-exist- ing cylinder." Surgically induced astigmatism was lower with the laser as well, "which may ultimately im- prove the accuracy of limbal relax- ing incisions and toric calculators," he said. Victus Gerd Auffarth, M.D., department of ophthalmology, University of Heidelberg, Germany, said when the laser gets approved in Europe and the U.S., "it will be the first platform to offer both cataract and refractive procedures," noting it can create a LASIK flap and can be used in ker- atoplasty, corneal crosslinking, and astigmatic keratotomy as well as cataract. Further, the system's curved interface means surgeons are induc- ing less pressure on the cornea, he said. His initial case series of seven eyes with black or brunescent cataract (some with pseudoexfolia- tion as well) resulted in 20/20 out- comes and no cases of capsule rupture. Michael C. Knorz, M.D., med- ical director, FreeVis LASIK Center, Mannheim, Germany, said the laser also "had an edge" over manual astigmatism correction because "multifocal IOLs will not tolerate any astigmatism greater than 0.5 D. The only limitation is that the pupil must be large enough to expose what you would like to laser." EW Editors' note: Dr. Alio has financial interests with Alcon. Dr. Auffarth has financial interests with Technolas. Dr. Culbertson has financial interests with OptiMedica. Dr. Knorz has no financial interests related to this article. Dr. Nagy has financial interests with Alcon. Dr. Nichamin has financial interests with LensAR. Dr. Seibel has financial inter- ests with OptiMedica. Dr. Talamo has financial interests with Alcon, B+L, and OptiMedica. EyeWorld Staff Writers Faith Hayden and Jena Passut assisted with this article. Contact information Alio: jlalio@vissum.com Auffarth: gerd.auffarth@ med.uni-heidelberg.de Culbertson: w.culbertson@miami.edu Knorz: knorz@eyes.de Nagy: nz@szem1.sote.hu Nichamin: nichamin@laureleye.com Seibel: idoc2020@me.com Talamo: jtalamo@lasikofboston.com January 2012