EyeWorld Asia-Pacific December 2012 Issue

7 December 2012 EWAP FEATURE On the edge of greatness? by Michelle Dalton EyeWorld Contributing Writer AT A GLANCE • Femto-phaco creates a perfect capsulorhexis every time • Because the capsulorhexis can be placed anywhere, effective lens position will improve • Learning curves are shorter for refractive surgeons than cataract surgeons but are not lengthy • This first generation group of femto-phaco lasers is just the beginning Early believers in femtosecond laser for refractive cataract surgery say this is just the beginning A utomated machines will always produce more consistent results and be able to do so quicker than performing the same chores manually. Still, in the case of femtosecond lasers for refractive cataract surgery, is that enough to warrant the investment? EyeWorld asked four leading cataract surgeons involved with the development of these lasers what attracted them to the technology and why they were among the first converts. While it would be difficult to argue that current cataract surgery is extremely effective, “there are some shortcomings, and the femtosecond laser is reducing the number of variables in our procedures,” said Sheraz M. Daya, MD , consultant and medical director, Centre for Sight, West Sussex, UK. For instance, manually dividing a lens can put stress on zonules; the Victus laser (Bausch + Lomb/Technolas, Rochester, NY, USA/Munich, Germany) can perform the same procedure, “almost identically from case to case,” Dr. Daya said. Jonathan H. Talamo, MD, associate clinical professor of ophthalmology, Harvard Medical School, and medical director, Surgisite Boston, Mass., USA, likens the femtosecond lasers in cataract surgery to the early femtosecond lasers developed for refractive surgery. “Those early devices weren’t doing something we couldn’t do ourselves,” he said. “But they added precision and accuracy.” Dr. Talamo has been involved in developing the OptiMedica Catalyslaser (Sunnyvale, Calif., USA) since 2007, and said these lasers achieve “greater precision with greater accuracy than manual techniques, and that will lead to greater safety.” Regardless of how fast a cataract surgeon can operate, “the machine will always be faster and more consistent,” said Mark Packer, MD, clinical associate professor, Oregon Health & Science University, and in private practice, Drs. Fine, Hoffman & Packer LLC, Eugene, Ore., USA. “I’m proud of my capsulorhexis and I’ve spent a lot of time working on it. But [the LensAR] is better, and it’s better every single time.” Likewise, the ability of the laser to center the capsulorhexis on the corneal apex or pupil center is something Dr. Packer said he’s unable to do manually. “I had heard about the advances in precision and reproducibility of the various steps, but actually using it and seeing it in action noticeably exceeded my expectations,” said Gary J.L. Foster, MD., in private practice, Eye Center of Northern Colorado, Fort Collins. Dr. Foster has been using the LenSx (Alcon, Fort Worth, Texas, USA/Hünenberg, Switzerland) since August 2011. The arcuate incisions and the capsulorhexis are “freakishly perfect” under the slit lamp, he said. Dr. Packer believes the cataract fragmentation capabilities of the lasers will translate into better safety. “I’ll have to do continued on page 8