EyeWorld Asia-Pacific September 2019 Issue

EWAP SEPTEMBER 2019 11 FEATURE I Ì ˆÃ >“>∘} ̜ ÀiyiVÌ on how rapidly cataract surgery continues to evolve,” Kendall Donaldson, MD, told EyeWorld . “Surgery continues to become less traumatic as we reduce energy put into the eye, ultimately increasing safety for patients while increasing the rate of visual recovery. “In addition, refractive outcomes continue to improve thanks to advances in technology.” As cataract surgery transitioned into a refractive outcome-driven procedure over the last decade, the wi`…>à Ãii˜ ܅>Ì ,œLiÀÌ Weinstock, MD, called “a storm of innovation and technological advances.” EyeWorld corresponded with Dr. Donaldson and Dr. Weinstock, as well as Sumit (Sam) Garg, MD, and Bryan ii] ] ̜ w˜` œÕÌ Ü…>Ì technological advances they use in their respective practices and how these technologies have improved their cataract surgery outcomes. Advancing today’s technologies Some advances have improved on existing technologies. Dr. Weinstock said that the LENSAR femtosecond cataract surgery laser (LENSAR) “has advanced tremendously with iris registration software to eliminate cyclotorsion error. By using preoperative imaging systems such as the Pentacam [Oculus], the Nidek OPD [Nidek], or the Cassini Total Corneal Astigmatism [Cassini Technologies], infrared images can now be sent directly and wirelessly to the LENSAR laser for a quick iris registration process once the patient is docked under the laser.” Dr. Weinstock uses this technology to improve astigmatic corrections by ensuring the correct axis for arcuate incisions and also customizing the capsulotomy’s shape to include marks useful for orienting a toric IOL implant. “Other advances in this platform are automatic nuclear density grading software applications to provide the most appropriate fragmentation pattern depending on the density of the nucleus, which ˆÃ ˆ“>}i` LÞ Ì…i -V…iˆ“«yÕ} imaging system,” he said. “We have the CATALYS femtosecond laser [Johnson & Johnson Vision],” Dr. Garg said. “FLACS [femtosecond laser-assisted cataract surgery] is particularly useful for dense cataract cases and for those with comorbidities such as Fuchs’ dystrophy and pseudoexfoliation. Also, the astigmatic incisions are much more precise than what I can accomplish freehand.” Dr. Lee offered a contrasting opinion on FLACS. “There is no good evidence that the femtosecond laser improves «…>Vœi“ՏÈwV>̈œ˜ ÀivÀ>V̈Ûi outcomes or safety,” he said. For intumescent cataracts, he occasionally employs the Zepto capsulotomy system (Mynosys Cellular Devices), a device consisting of a thin nitinol wire loop that delivers heat to cut a consistent, perfectly round capsulotomy. “This capsulotomy happens faster than a femtosecond laser, which gives iÃà ̈“i vœÀ ˆµÕˆwi` VœÀÌiÝ Ìœ interfere with the cut when the capsule is under pressure.” Phaco machines have also seen advances. Dr. Donaldson said that these machines now …>Ûi “œÀi ivwVˆi˜Ì yՈ`ˆVÃ] with custom energy cycles such >à “œ`ˆwi` LÕÀÃÌ >˜` «ÕÃi settings, and improved machine tubing that allows optimization of phaco parameters. Advances in biometry One existing technology that has steadily improved through the years is the biometry device. All the physicians interviewed for this article cited the IOLMaster 700 swept source OCT biometer (Carl Zeiss Meditec) as one of A storm of innovation How technology improves cataract surgery outcomes by Chiles Aedam R. Samaniego EyeWorld æÈ>‡*>VˆwV Senior Staff Writer 6JKU CTVKENG QTKIKPCNN[ CRRGCTGF KP VJG /C[ KUUWG QH EyeWorld . It has been UNKIJVN[ OQFKƂGF CPF CRRGCTU JGTG YKVJ RGTOKUUKQP HTQO VJG #5%45 1RJVJCNOKE Services Corp. Contact information Donaldson: KDonaldson@med.miami.edu Garg: gargs@uci.edu Lee: bryan@bryanlee.pro Weinstock: rjweinstock@yahoo.com AT A GLANCE • The last decade has seen “a storm of innovation and technological advances” attending cataract surgery’s transition into a refractive outcome-driven procedure. • Advances to existing technologies such as femtosecond laser «>ÌvœÀ“à >˜` «…>Vœi“ՏÈwV>̈œ˜ machines along with new technologies improve surgeons’ ability to carry out each step of the cataract surgery procedure with a high degree of accuracy and precision while reducing risk. • Cataract and refractive surgeons alike look forward to and will Li˜iwÌ vÀœ“ ÌiV…˜œœ}Þ Ì…>Ì will allow them to modify sphere and cylinder postoperatively. Toric IOL placed perfectly on the refractive capsulotomy nub created by the LENSAR IntelliAxis-L system. Source: Robert Weinstock, MD