EyeWorld Asia-Pacific September 2015 Issue

19 September 2015 EWAP FEATURE What’s new in cataract suites by Michelle Dalton EyeWorld Contributing Writer Beyond femtosecond lasers, cataract surgeons have a bevy of new options to consider A dd enough incremental improvements together and ultimately you will have a significant step forward. “Five or 10 years from now, that’s how we’ll view the past few years in cataract device improvements,” said Richard S. Hoffman, MD , clinical associate professor of ophthalmology, Casey Eye Institute, Oregon Health & Science University, and in private practice at Drs. Fine, Hoffman & Sims, Eugene, Ore. A “true accommodating lens” would be a “big jump forward,” he said, but year-on-year there are not likely to be major improvements in lens technologies. He is, however, intrigued with dropless cataract surgery. With the cost of some generic drugs just as expensive (and in some cases, more expensive) as the named version, Dr. Hoffman said he expects more surgeons to slowly move over to dropless cataract surgery. Kendall E. Donaldson, MD , Bascom Palmer Eye Institute, Miami, Fla., is taking a more reserved approach and has not yet adopted the dropless technique, calling it a “promising but somewhat controversial topic because it requires placing a needle through the zonules. I’ve held out on incorporating this into my practice because it seems as cataract surgeons we spend A toric IOL aligned using the Callisto system in the presence of signi cant stromal hydration of incisions Source: Richard S. Hoffman, MD our whole life trying to avoid disruption of the zonules.” In general, however, Dr. Donaldson thinks the concept is long past due, especially as it alleviates the rising cost of medications for the patient. Both surgeons agree that the integration of technology over the past year or so has been the key to improving cataract surgery. “Combining technology among different companies and getting the companies to work cooperatively is crucial to achieving our best results,” Dr. Donaldson said. For instance, integrated cataract suites allow surgeons to enter postop data to create their own customized nomograms, regardless of which manufacturer developed which piece of the puzzle. “The nomogram becomes more robust as more postoperative data is entered into the system,” she said, and that translates to better patient outcomes. Technology improvements Dr. Hoffman has been impressed with devices that measure both anterior and posterior curvature to provide the overall corneal power, “which is very useful for toric IOL calculations,” he said. “We’re looking at retrofitting our microscope with a Callisto system just so we don’t have to keep marking our patients.” Jena, Germany-based Carl Zeiss Meditec’s Callisto computer-assisted surgery system incorporates the company’s IOLMaster device and the OPMI Lumera microscope, he said. “By working in harmony, the Callisto will tell you where to line up the toric IOL,” Dr. Hoffman said. This small “but urgently needed step forward eliminates surgeon frustration.” Typically, patients head into the operating room 30–40 minutes after their cornea has been marked, “so the mark has spread and you have to guess where 12 and 6 o’clock are,” he said. The Callisto is “a much more precise measurement.” Dr. Donaldson said Alcon (Fort Worth, Texas) is “probably the best example of integration,” because the company bought the LENSTAR technology from Haag-Streit (Köniz, Switzerland) and has since acquired the ORA intraoperative aberrometry system from WaveTec. “Surgeons can now take the information from the LENSTAR, input it into the Verion [Alcon], head to the femtosecond LenSx [Alcon], and the operating microscope and all the information seamlessly flows as the preoperative plan is translated into the operating room,” she said. “Zeiss is doing the same thing with its Callisto, IOLMaster, and Lumera, and Bausch + Lomb [Bridgewater, NJ] is doing the same thing with the VICTUS laser and the Cirle system.” LENSAR (Orlando, Fla.) received 510k clearance from the U.S. Food and Drug Administration for a suite of five new application technologies integrated into the company’s laser system. The five new applications are wireless integration with the Cassini corneal shape analyzer (i-Optics, The Hague, the Netherlands), iris registration, cataract density imaging, customized fragmentation patterns, and arcuate incision planning. The system is the first to enable wireless transfer of data from preop corneal measurements to the femto laser. Dr. Donaldson said improvements in phaco fluidics are exciting, too. At Bascom Palmer, she’s moved from the Infiniti to the Centurion (both Alcon), continued on page 20