EyeWorld Asia-Pacific June 2014 Issue

June 2014 26 EWAP FEAturE No dice by Maxine Lipner EyeWorld Contributing Writer Why some are rebuking femtosecond laser cataract surgery I f you had a cataract, would you prefer to undergo traditional or femtosecond cataract surgery? When members of the ASCRS cataract listserv were asked this in a survey conducted by Gary Wortz, MD , Lexington, Ky., U.S., 91.9% of non-user surgeons responded that they would prefer manual to femtosecond cataract surgery for their own eyes, according to Steven G. Safran, MD , Lawrenceville, NJ, U.S. What’s more, 98% of these surgeons said they believe the femtosecond laser is being used as “a marketing tool to attract new patients.” Dr. Safran views such responses as a powerful statement of the silent majority who, he believes, is turning away from femto cataract surgery. The claim that a perfectly round, centered capsulorhexis created by a laser will lead to With meticulous lens epithelial cell cleanup, the capsular bag changes little over time, and whether the rhexis was perfectly round and centered initially becomes irrelevant, according to Dr. Safran. Source (all): Steven G. Safran, MD 1 week postop 2 years postop 10 months postop 16 months postop significantly improved refractive outcomes was dismissed by the majority here, Dr. Safran said. Only 4% believe this plays a significant role in improving refractive outcomes, in contrast with 79% who feel it is not a significant factor, he reported. The idea that the rhexis plays an important role in effective lens positioning was disproved in a study by Oliver Findl, MD , Dr. Safran said. This prospective study’s results were reported at the 2013 European Society of Cataract & Refractive Surgeons Congress and showed that the rhexis size and shape had no significant effect on effective lens position, tilt, or decentration, and thus were irrelevant to refractive outcomes with modern IOLs. “The rhexis can only influence the position of the optic to the extent that it can distort the structural relationship between the optic and the haptic as set by the IOL manufacturer,” he said. “That isn’t very much with modern one- piece IOLs.” Under the hype? Even when the cost of femtosecond laser was factored out of the equation, it had little bearing on what surveyed surgeons would choose for their own eyes. Specifically, when asked what they would choose for their own eyes if they had 1.25 D of corneal astigmatism and wished to address this at the time of cataract surgery, the vast majority (85%) selected manual phacoemulsification with a toric IOL. Further, the slightly higher price tag of $1,250 opposed to $1,000 for femtosecond phaco didn’t dissuade them, Dr. Safran observed. Just 2% of practitioners said they would opt for the femtosecond-assisted phaco and laser LRI approach versus 85% who would choose the manual procedure with a toric IOL despite the higher cost for the latter. Dr. Safran views this as indicating that many ophthalmologists see the use of the femtosecond laser for cataract surgery as “less effective than the hype surrounding it.” “Who wants to buy a [US]$500,000 device unless it provides real benefit? You have to pay for this. You have to recruit people and try and convert them,” Dr. Safran said. “What are you telling patients about why they should have this done? We’ve heard people say, ‘I think it’s better, more accurate, and more precise.’ The ophthalmologists in this survey didn’t think so.” Studying safety New study results have called into question whether making the rhexis with the femtosecond laser is indeed safer. Dr. Safran pointed to a study published in the January issue of Ophthalmology on anterior capsulotomy integrity after femtosecond-assisted cataract surgery. “In this study, the tear- out rate was 15 times higher with the femtosecond laser than with a manually created rhexis. In every case, the rhexis tore out continued on page 28