EyeWorld Asia-Pacific March 2012 Issue

3 March 2012 Letter from the Editor Dear Friends E very now and again we are faced with new technology which potentially could change the way we perform surgery in our daily practice. Femtosecond cataract surgery is indeed such a technology and is discussed in detail in this issue of EyeWorld Asia- Pacific . I am sure that the technology will be part of our future practices but it is worth taking a critical look at the claimed advantages of the femtosecond laser with respect to the incision, fragmentation and performing the capsulorhexis. Incision security depends largely on the construction and size of the incision and is unlikely to be dramatically improved by femtosecond technology. Although femtosecond softening of the lens does reduce phaco energy, I am uncertain whether this in itself would be sufficient to justify the expense of purchasing this type of equipment. We are all familiar with past attempts of adjunctive technology to phaco such as Neosonix and Aqualase, which, though able to reduce the energy required to remove a cataract, were only able to engage surgeons’ interest temporarily. So it seems that the prospect of being able to perform a consistent, more accurate capsulorhexis is the major technical benefit of this new procedure. It has been claimed that a femto-rhexis would improve safety, but there have been reports of rhexis tears due to unforseen tags and even dropped nuclei due to capsular block phenomenon during hydrodissection. These complications could be minimized as surgeons become more familiar with how to apply this technology. The hope is that a more consistent rhexis will improve refractive outcomes and theoretically this could indeed be correct. A method which creates a rhexis with a consistent size and shape is likely to result in less variation in the axial position of an implant and therefore a more predictable effective lens position of the intraocular lens (IOL). Nevertheless there is considerable noise in predicting refractive outcomes. IOLs are typically labelled in 0.5-diopter increments and the accuracy of refraction is in the range of a quarter diopter. It may prove difficult, therefore, to demonstrate the improved accuracy which is likely to be less than 0.25 D in prospective studies. Despite these cautions, the option of laser technology to remove cataracts has quite widespread appeal both to surgeons and patients. The issues which still need to be addressed are economic, the cost-effectiveness of the procedure. At present this entails a significant capital outlay as well as on- going consumable costs and procedure fees. I suspect that strategies will become apparent to address these issues and femtosecond cataract surgery will be more widely performed in the future. I do believe it is wise for surgeons to have a clear understanding of the technical as well as socioeconomic issues in deciding whether the time is right to consider moving to femtosecond cataract surgery or perhaps wait until some of these issues are addressed. Finally, I would like to extend a personal invitation to our readers to join us for our 25th APACRS Annual Meeting to be held in conjunction with the 14th Congress of the Chinese Cataract Society to be held in Shanghai from 31 May to 3 June 2012. Shanghai is the ideal place to explore our theme of “The Sophisticated Surgeon - Elegant, Efficient, Excellent”, reflecting the city’s own level of sophistication. See you in Shanghai! Warmest regards Graham Barrett, MD President, APACRS Chief Medical Editor, EyeWorld Asia-Pacific