EyeWorld Asia-Pacific June 2016 Issue

3 EWAP June 2016 Letter from the Editor Dear Friends F emtosecond laser-assisted cataract surgery (FLACS) has currently become a centerpiece of discussion for a mixture of advocates and skeptics. This issue contains six articles covering numerous aspects of this technology which include current status, experts’ perspectives and techniques for nucleus disassembly, and capsulotomy. Skeptics point out that the technology achieved no clinically improved safety, efficacy, and refractive outcomes over conventional surgeries, with the exception of astigmatism correction. And a possible negative to FLACS would include long operating time, high costs, increased risk of anterior capsule tear and potential inconveniences associated with its use. While recently published meta-analyses by myself, Dr. Xinyi Chen and others ( PLOS ONE, 2016 March) and Drs. Xiaoyun Chen, Yizhi Liu, et al. ( Scientific Reports, 2015 Aug) revealed that this method wins over manual surgery with less phaco energy, endothelial cell loss, and postoperative central corneal thickening, as well as faster visual recoveries. In our eye center, we did 1,000 cases of FLACS and 10,000 of phaco last year. In my personal experience, I advocate the application of this technology in complicated cases including lens subluxation, pseudoexfoliation syndrome, dense or mature cataract, and patients with low corneal endothelial density, with which the advantages of precise capsulorhexis and high safety profiles have been affirmed by evidence to date and our initial study. Additionally, I believe that our primary goal as surgeons is to achieve better outcomes rather than accounting for financial issues. The technology is now being rapidly adopted worldwide and included in this issue are several most valuable tips and perspectives by Dr. Shamie, Dr. Chang, and Dr. Safran which should be helpful to surgeons considering bringing FLACS into their practice. Moreover, it should also be noted that the technology does have a learning curve and according to my experience complications are expected to be markedly reduce after the first 100 cases. Continuing the discussion of FSL application, another article by Dr. Gossman features the methods for nucleus division in phacoemulsification. There is great diversity in the methods employed and the choice would largely depend on lens density in various disassembly cases. I agree with his preference for femto cataract surgery when faced with dense cataracts for its safety, efficiency, and lower phaco power requirements, which has been confirmed by our initial comparative data of 72 cases. The recent update on small incision lenticule extraction (SMILE) explores the benefits and potential barriers of this procedure. The SMILE technology which was first introduced in 2011 represents a recent addition to the refractive surgeon’s range of procedures. Europe and Asia, especially China, are the key markets for this technology. In China, more than 140 SMILE apparatuses have been installed; over 140,000 cases have been performed to date. It is estimated that 100,000 SMILE cases (10% vs. LASIK) will be completed this year, which is predicted with a continued rising trend. According to Dr. Dell in this issue, it has advantages over LASIK in biomechanics as far as disturbance to corneal surface, epithelial ingrowth, and corneal nerve damage. A recent published meta-analysis by Zhang Y ( Journal of Refractive Surgery , 2016 Apr) and our revised meta-analysis both revealed that SMILE is safe and efficient and may create fewer dry eye symptoms and greater corneal sensitivity than FS-LASIK. The decline in LASIK volumes around the world remains another challenging issue. Experts from around the globe assess that the economic factor and misconceptions delivered by mass media could be the incentive for market decline. The article titled “LASIK worldwide” in this issue provides several recommendations for the downtrend of this technology including appropriate patient selection and education as well as good marketing techniques which might help to re-energize this life-changing procedure. In my personal view, I would remain positive about the adoption of this method as well as SMILE for myopia correction which would be helpful for the stability and enhancement of the refractive surgery market and patients’ growing needs. Another interesting topic focusing on multifocal IOL selection stresses that the choice should take into account the patients’ age, lifestyle, occupation, cultural differences, and an individual’s unique eye situation. The surgeons state that proper MFIOL patient selection should be based on their ocular findings, previous refractive surgery, and psychological factors. Whether FSL technology during MFIOL implantation would be beneficial for astigmatism correction remains contentious. This issue also includes articles on Zepto Precision Pulse Capsulotomy (PPC) device, Boston type 1 keratoprosthesis (KPro) artificial cornea, IOL options for presbyopia correction, perioperative aberrometry, usage of NSAIDs and other innovative drugs for cataract surgery. I admire all contributing authors for their expertise and invaluable contribution to this issue. With this brief overview, I invite you to enjoy the articles and hope that all readers would find each article full of practical information and be able to translate that to your daily work. Sincerely, YAO Ke Guest Editor Vice President, Asia-Pacific Association of the Cataract and Refractive Surgeons (APACRS) President, Chinese Cataract Society (CCS) EYEWORLD ASIA-PACIFIC EDITORIAL BOARD C HIEF MEDICAL EDITOR Graham BARRETT, Australia MEMBERS Abhay VASAVADA, India ANG Chong Lye, Singapore CHAN Wing Kwong, Singapore CHEE Soon Phaik, Singapore Choun-Ki JOO, Korea Hiroko BISSEN-MIYAJIMA, Japan ASIA-PACIFIC CHINA EDITION Editors-in-Chief ZHAO Jialiang ZHAO Kan Xing Deputy Editor HE Shouzhi Assistant Editor ZHOU Qi ASIA-PACIFIC INDIA EDITION Regional Managing Editor S. NATARAJAN ASIA-PACIFIC KOREA EDITION Regional Editor-in-Chief Hungwon TCHAH Regional Managing Editor Chul Young CHOI Hungwon TCHAH, Korea John CHANG, Hong Kong Johan HUTAURUK, Indonesia Kimiya SHIMIZU, Japan Pannet PANGPUTHIPONG, Thailand Ronald YEOH, Singapore S. NATARAJAN, India Sri GANESH, India YAO Ke, China Y.C. LEE, Malaysia