EyeWorld Asia-Pacific December 2012 Issue

December 2012 10 EWAP Feature AT A GLANCE • In eliciting the problem from unhappy patients, some practitioners attempt to drill down on a single problem • Many patients return years after surgery with complaints of recurrent refractive error, which may be related to problems of aging such as presbyopia or cataracts • For some patients where surgery isn’t an option, a neurological approach or even use of specialty contact lenses may be the answer for the interim Assessing femto-assisted astigmatism by Vanessa Caceres EyeWorld Contributing Writer Users praise advantages, cite need for better nomograms P redictability and control: Those are two words you commonly hear when you ask surgeons about the advantages of using femtosecond lasers for astigmatism treatment. These same surgeons acknowledge that this is still an evolving technology that needs long-term results and better nomograms to assist during procedures. “In general, the femtosecond laser has the potential to make incisions precisely in the position, depth, and angulation that is desirable. It’s extremely predictable in terms of the depth of the incision and in the optic zone,” said William W. Culbertson, MD , professor of ophthalmology, and director, Cornea and Refractive Surgery Services, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Fla., USA. “You can do this with more precision than you can with a blade.” With a blade, the depth created is not as uniform as it will be when created by a laser, Dr. Culbertson added. EyeWorld spoke with surgeons experienced with the OptiMedica (Sunnyvale, Calif., USA), LensAR (Winter Park, Fla., USA), and LenSx (Alcon, Fort Worth, Texas, USA/Hünenberg, Switzerland) lasers to hear their thoughts on their respective models for use in astigmatic cataract patients. Wavefront-guided refraction during cataract and refractive lens exchange surgery Source: Mark Packer, MD OptiMedica experience OptiMedica’s Catalys laser system has been in the news recently with the U.S. FDA’s approval of its corneal incisions. Jonathan H. Talamo, MD , associate clinical professor of ophthalmology, Harvard Medical School, Boston, Mass., USA, has worked with the company for 5 years to assist in the laser’s design and has 3 years of experience with the OptiMedica laser, performing procedures in the Dominican Republic. He anticipates obtaining a model soon for treatment. “When we proceed with the laser, the cuts we do should have finely positioned diameter, length, depth, and centration,” he said. “The laser allows more reproducibility, and when you combine it with optical coherence tomography, you can tell the laser how deep to go in every spot.” That standardization of astigmatic incisions was also something discussed by Dr. Culbertson. Dr. Culbertson has 3 years of experience with the OptiMedica laser, performing procedures in the Dominican Republic. With the laser, surgeons can use the bevel direction to help stabilize the effect of the incisions—something that you cannot standardize manually, Dr. Culbertson said. “You can make these titratable—you can make the incision but not open it all the way to the bottom so the residual adhesions can remain intact at a certain position and depth. For example, you can treat 3 diopters and make the incision, but it