EyeWorld Asia-Pacific June 2019 Issue

44 EWAP JUNE 2019 E yeWorld ƂÈ>‡*>VˆwV asked doctors in the region their thoughts on whether femtosecond laser-assisted cataract surgery adds value to premium practice. The following text gathers their commentary, lightly edited and, where possible to present a discursive framework, interpolated and restructured around three main µÕiÃ̈œ˜Ã\ £® œ ÞœÕ ÕÃi Ƃ - and to what extent is it part of your practice? (2) Would you ÀiVœ““i˜` Ƃ - ̜ œÌ…iÀ surgeons and when/how should ÃÕÀ}iœ˜Ã ÕÃiÉ>ۜˆ` Ƃ -¶ ή What are your reasons for using/ not using, recommending/not ÀiVœ““i˜`ˆ˜} Ƃ -¶ Hiroko Bissen- Miyajima, MD (Tokyo, Japan): …>Ûi Lii˜ ÕȘ} Ƃ - since 2013. Ƃ - ˆÃ ˜œÌ Àiˆ“LÕÀÃi` LÞ public health insurance in Japan, and at my hospital this procedure is limited to cases with presbyopia-correcting ˆ˜ÌÀ>œVՏ>À i˜Ãià " ®] ܅ˆV… «>̈i˜Ìà «>Þ vœÀ œÕÌ œv «œVŽiÌ° ˜ >``ˆÌˆœ˜] Ƃ - ˆÃ ÕÃi` ˆ˜ V>Ãià ܈̅“œ˜œvœV> " ܅i˜ ̅i V>Ì>À>VÌ ˆÃ “>ÌÕÀi œÀ ̅i ✘Տ> ˆÃ œœÃi° >Ãœ Ãii ̅i Li˜iwÌ œv Ƃ - ˆ˜ ÌÀ>ˆ˜ˆ˜} ÀiÈ`i˜Ìà by safer and effective ways. Under these circumstances, we have done over 3,000 cases and are very enthusiastic. We installed a femtosecond laser in our operating room (OR),and the entire cataract procedure is done using a movable reclining V…>ˆÀ ˆ˜ ̅i ",° «iÀvœÀ“ È V>Ãià œv Ƃ - ˆ˜ £…œÕÀ ÕȘ} 1 operating table, which is the same as that of a conventional procedure. Chee Soon Phaik, MD (Singapore): …>Ûi ÕÃi` four laser platforms and done Î]xää V>Ãià ȘVi Óä£Ó° œvviÀ Ƃ - ̜ “Þ «ÀˆÛ>Ìi «>̈i˜Ìà with 90 to 100% uptake. About 80% of my cases are toric and 50% are presbyopia-correcting " ð iˆ˜} >Li ̜ Vœ˜ÃˆÃÌi˜ÌÞ achieve a 5-mm, round, well-centered capsulotomy is important in achieving predictable refractive outcomes ˆ˜ ̅iÃi «Ài“ˆÕ“ " ð ÕÃi Ƃ - ÀœṎ˜iÞ vœÀ brunescent, posterior polar, subluxated, white, traumatic cataracts and eyes with low endothelial cell count or anterior V>«ÃՏi wLÀœÃˆÃ° ˜ “Þ…>˜`Ã] surgery is safer using the laser than manual methods. Johan Hutauruk, MD (Jakarta, Indonesia): Ƃ -…>à already been available for more than one decade but the advantages over «…>Vœi“ՏÈwV>̈œ˜ >Ài Ã̈ debatable. There are many peer-reviewed articles, the most recent a multicenter study by Manning et al. and they vœÕ˜` ̅>Ì LœÌ…Ƃ - >˜` «…>Vœi“ՏÈwV>̈œ˜ «ÀœÛˆ`i` excellent visual outcomes with no evidence to support V>ˆ“à ̅>Ì Ƃ - ˆÃ ÃÕ«iÀˆœÀ ̜ conventional phaco. ˜ “Þ œ«ˆ˜ˆœ˜] ̅i >`œ«Ìˆœ˜ œv Ƃ - ˆÃ ÛiÀÞ ÃœÜ >vÌiÀ “œÀi than 10 years in the market, and ˆÌ ˆÃ LiV>ÕÃi ̅i VœÃÌ œv Ƃ - ˆÃ È}˜ˆwV>˜ÌÞ…ˆ}…iÀ ܅ˆi the effectiveness is statistically ˜œÌ È}˜ˆwV>˜Ì Vœ“«>Ài` ̜ Vœ˜Ûi˜Ìˆœ˜> «…>Vœ° v ̅i VœÃÌ œv Ƃ - V>˜ Li Ài`ÕVi`] ˆÌ ܈ certainly have better adoption for cataract surgeons. ÃÌ>ÀÌi` ÕȘ} Ƃ - ˆ˜ Óä£Ó ܈̅i˜-Ý >˜` VÕÀÀi˜ÌÞ >Ãœ use another platform, the Femto 6 <n° /…i i˜-Ý ˜ii`à > separate room for temperature and humidity control while the i“Ìœ 6 <n ˆÃ “œÀi Vœ“«>VÌ and may be put side by side with the phaco machine—but both platforms still need longer operating time. Mahipal Sachdev, MD (New Delhi, India): Ü>à one of the earlier adopters of femtosecond assisted cataract surgery since it was introduced in 2012. There has been a distinct increase in the patients opting for this technology over the past seven FLACS in premium practice: An international perspective 'FKVQTUo PQVG &T $KUUGP /K[CLKOC KU C EQPUWNVCPV HQT #NEQP ,QJPUQP ,QJPUQP 8KUKQP *Q[C <GKUU CPF 5CPVGP &T %JGG TGEGKXGU VTCXGN UWRRQTV CPF RQFKWO HGGU HTQO #NEQP $CWUEJ .QOD 6GEJPQNCU ,QJPUQP ,QJPUQP 8KUKQP CPF <KGOGT 1RJVJCNOKE 5[UVGOU &T *WVCWTWM FGENCTGF PQ TGNGXCPV ƂPCPEKCN KPVGTGUVU &T 5CEJFGX KU C EQPUWNVCPV HQT CPF QP VJG )NQDCN #FXKUQT[ $QCTF QH ,QJPUQP ,QJPUQP 8KUKQP &T 7[ KU C EQPUWNVCPV HQT #NEQP CPF .GPUCT &T ;GQJ KU QP VJG URGCMGT RCPGNU QH #NEQP ,QJPUQP ,QJPUQP 8KUKQP CPF <GKUU Contact information Bissen-Miyajima: bissen@tdc.ac.jp Chee: chee.soon.phaik@snec.com.sg Hutauruk: johan.hutauruk@gmail.com Sachdev: drmahipal@gmail.com Uy: harveyuy@yahoo.com Yeoh: ry@ers.clinic CATARACT