EyeWorld Asia-Pacific June 2014 Issue

11 June 2014 EWAP FEAturE Operating on the laser’s edge Femtosecond cataract outcomes B lade-free cataract surgery is on a lot of practitioners’ minds these days as practices begin to incorporate the technology, akin to their refractive brethren a few years back with femtosecond LASIK. EyeWorld wondered about the effect on outcomes with femtosecond cataract surgery. From astigmatism correction to effective lens position and beyond, here’s what you can expect with femtosecond technology. Jack T. Holladay, MD , MSEE, FACS , professor of ophthalmology, Baylor College of Medicine, Houston, Texas, U.S., said that the introduction of bladeless cataract surgery and that of femtosecond refractive surgery is very similar. “We always jump in and think, ‘What is the actual scientific evidence for improvement?’ and that’s going to The ASSORT femto LRI calculator allows planning of LRI procedures with well-known nomograms, together with postoperative astigmatism analysis using the Alpins Method. Source: Noel Alpins, MD Corneal topographic astigmatism (CorT) better matches the manifest refractive cylinder (R) than simulated keratometry (Sim K), according to Dr. Alpins. Source: Noel Alpins, MD AT A GLANCE • Femtosecond incisions offer precise depth and size unmatched by the manual approach, surgeons say. • Incisions can be titrated postop for more precise outcomes. • The jury is still out on whether or not effective lens position is improved in femtosecond cataract cases. by Maxine Lipner EyeWorld Senior Contributing Writer be related to the adoption by the doctors,” Dr. Holladay said. “When the IntraLase [Abbott Medical Optics, Santa Ana, Calif., U.S.] first came out, the same questions were raised in terms of comparing the microkeratome to the femtosecond keratome.” People wondered whether use of the femtosecond made a difference. Dr. Holladay said while there were some differences in femtosecond LASIK outcomes in terms of visual acuity and contrast sensitivity, you would be hard- pressed to find a study showing this. “Yet in a period of two to three years, the femtosecond completely took over 90% of the market in terms of femtosecond LASIK,” he observed. It was the difference perceived by patients in the chance of having a catastrophic complication with mechanical microkeratomes that was the driving force with femtosecond LASIK, he explained. “People are afraid of blades. They don’t like the idea of cutting,” he said. “The laser is perceived as safer.” The laser is safer and more precise, Dr. Holladay said. “With cataract surgery when the laser makes the primary cataract incision, the secondary incision, the AK cut, everything that it does, the precision with which it does that is an order of magnitude 10 times better than a surgeon can do,” he said. Creating and continued on page 12