Eyeworld

EW CATARACT 44 August 2017 Research highlight by Maxine Lipner EyeWorld Senior Contributing Writer when first performing FLACS since they do not have the same founda- tion from which to draw. Clinical potential In addition to finding that the ante- rior capsulotomy was more efficient with the femtosecond approach, there was another intriguing finding with the emerging technique. "It was interesting that the difference of the mean total room time only slightly exceeded the difference of the mean operative time, which sug- gested to us that the laser pretreat- ment performed in the same OR did not substantially increase average room time," Dr. Pittner said. This was contrary to what investigators expected to find, with some conjec- ture that laser treatment would be a particularly time-consuming step. While the femtosecond ap- proach takes more time for residents at the moment, Dr. Pittner remains optimistic about its clinical poten- tial. "Overall, I think FLACS will emerge as a better solution in cata- ract surgery learning for residents in the future," he said. However, first it is going to take more studies akin to this one to help uncover areas for improvement of training practices. Overall, Dr. Pittner hopes that practitioners come away from the study with the understanding that this is still an emerging technolo- gy. "I hope that people look at this paper and realize that now we are starting to publish data on FLACS, it's being incorporated into resident training more, and it needs to be explored further," he said. "Resident education in FLACS is still in its infancy with less than one-third of programs currently teaching it, but there is no doubt that this num- ber will grow." Going forward, Dr. Pittner foresees the emergence of more published data leading to a widespread acceptance of FLACS in training programs. EW Reference 1. Pittner AC, et al. Resident surgeon efficiency in femtosecond laser-assisted cataract sur- gery. Clin Ophthalmol. 2017;11:291–297. Editors' note: Dr. Pittner has no finan- cial interests related to his comments. Contact information Pittner: apittner49@gmail.com Examining residents' efficiency with FLACS S ome ophthalmology res- idents today are learning to perform femtosecond laser-assisted cataract sur- gery (FLACS) in addition to traditional phacoemulsification. New study results suggest that this may be a more time-consuming mo- dality for residents than traditional phacoemulsification, according to Andrew Pittner, MD, resident, Rush University Medical Center, Chicago. 1 Investigators in this recent study wanted to see how residents were adapting to the novel femtosecond technology. "The femtosecond laser is a newer technology being imple- mented into a lot of residency pro- grams and academic medical insti- tutions, and there hasn't been much literature published on efficacy of use or how it's being incorporated into those settings," Dr. Pittner said. "After doing a literature search [that came up with little], we wanted to start that movement by publishing an article exploring resident training with FLACS technology." The technology is already being used by many training programs and more are likely to add FLACS in the near future. "More than 21% of the U.S. residency programs actively train residents to perform FLACS at their institutions," Dr. Pittner said, adding that there are currently numerous programs planning to in- corporate FLACS into their teaching curriculum within the next 1 to 5 years. Comparing approaches The authors first conducted a wide literature search, honing in on keywords such as femtosecond laser and resident education. They tried to include anything that dealt with the femtosecond laser in resident training, Dr. Pittner noted. As part of the study, investiga- tors compared five of the critical steps in traditional cataract surgery to FLACS, while also considering the duration of the procedures and total room times. They determined that while the femtosecond laser en- hanced resident performance in one step, in other regards it was either neutral or less efficient. "We found that completion of the capsulotomy was more efficient in the FLACS group. The capsulotomy is a critical portion of the procedure and is gen- erally considered one of the most difficult and hazardous steps for residents to learn," Dr. Pittner said. "Our findings suggest that automat- ed anterior capsulotomy with FLACS may eventually emerge as a better solution in cataract surgery educa- tion for residents." Complication rates were found to be essentially equivalent, with no statistically significant difference be- tween the groups, he reported. "The other steps that we looked at were the completion of incisions, the anterior capsulotomy, the nucleus removal, the cortical removal, and the intraocular lens implantations," Dr. Pittner said, adding that comple- tion of incisions, operating times, and overall total room times were all found to be significantly longer for those in the FLACS group. When investigators consid- ered why residents may face more challenges with the femtosecond approach than already established practitioners learning FLACS, they posited that general experience may play an important role here. "One of the theories is that despite the challenges faced by experienced ophthalmologists, their learning process with FLACS is facilitated by their advanced foundation of micro- surgical skills," Dr. Pittner said. By contrast, resident surgeons may face a more demanding learning curve Femtosecond in training

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