EyeWorld Asia-Pacific September 2015 Issue

Femto cataract clinical update September 2015 36 EWAP SECONDARY FEATURE Femtosecond laser experiences around the world by Ellen Stodola EyeWorld Staff Writer AT A GLANCE • One major barrier to the adoption of the femtosecond laser for cataract surgery is cost. Many patients must pay out of pocket for the technology, and in Ireland, the lack of insurance coverage has so far prevented the technology from being used. • Advantages of using the femto laser are that less phaco energy is used, and the laser can make consistently rounder capsulorhexes, according to surgeons. • Although the bene ts over standard phaco are not necessarily clearly de ned in routine cases, the femtosecond laser can be particularly bene cial for complicated cataracts. Surgeons in different countries share their experiences adopting the femtosecond laser into practice T he experience of incorporating the femtosecond laser for cataract surgery into practice has been different for surgeons around the world. Michael Lawless, MD , clinical associate professor, University of Sydney, and ophthalmic surgeon, Vision Eye Institute, Sydney, Australia; Arthur Cummings, MD, Wellington Eye Clinic and Beacon Hospital, Dublin, Ireland; and Ronald Yeoh, MD, consultant eye surgeon and medical director, Eye & Retina Surgeons, Singapore, spoke about the introduction and adoption of femtosecond laser cataract surgery in their experience. Adoption of femto Dr. Lawless was the first surgeon to introduce the femtosecond laser to Australia in April 2011. “In the first 2 years, the number of femtosecond lasers available increased more quickly than I would have anticipated so that there were more than 20 units installed, allowing access to the technology in almost all major cities,” he said. However, Dr. Lawless said, after 2013, the number of installations stopped and did not expand in the way that he thought they would. “Back in 2011, I thought there would be a slow up-take but then it would build momentum so that it became a very commonly performed procedure,” he said. “Within Australia approximately 6% of cataract and refractive lens procedures are performed with the femtosecond laser, and this mirrors very closely the percentage of multifocal lenses used within the country as well.” In Dr. Lawless’ personal practice, he has been using the femtosecond laser for the majority of his cataract cases since 2011. “Currently I use it in 95% of cases, and the 5% where it is not used are mainly financial impediments or less commonly technical reasons,” he said. Additionally, he thinks that in certain cases, like with Fuchs’ dystrophy, pseudoexfoliation, or white cataracts, it provides a clear advantage in safety. “I think this increase in safety for an individual patient applies across the spectrum of cataract and lens surgery, so for that reason I offer it to everybody.” Meanwhile, femtosecond laser-assisted cataract surgery (FLACS) arrived in Singapore in 2012, Dr. Yeoh said, with two machines purchased and placed in private hospitals and two additional purchased and placed in institutions. “Interestingly, the volume of FLACS has been significantly higher in institutional practice than in private,” he said. “I ascribe this trend to the presence of more cutting-edge cataract surgeons in the institutions than in the private sector.” Some of the private surgeons are reluctant to learn and embrace a new, expensive procedure that has not yet been proven superior. “I have practices that straddle both these sectors and perform FLACS at each location equally, as I A round and centered femtosecond laser-created capsulorhexis with a nicely positioned implant is the main reason for FLACS success, according to Dr. Yeoh. Source: Ronald Yeoh, MD