EyeWorld India March 2012 Issue

3 March 2012 Letters from the Editors Dear Friends E very now and again we are faced with new technology which potentially could change the way we perform surgery in our daily practice. Femtosecond cataract surgery is indeed such a technology and is discussed in detail in this issue of EyeWorld Asia-Pacific . I am sure that the technology will be part of our future practices but it is worth taking a critical look at the claimed advantages of the femtosecond laser with respect to the incision, fragmentation and performing the capsulorhexis. Incision security depends largely on the construction and size of the incision and is unlikely to be dramatically improved by femtosecond technology. Although femtosecond softening of the lens does reduce phaco energy, I am uncertain whether this in itself would be sufficient to j ustify the expense of purchasing this type of equipment. We are all familiar with past attempts of adj unctive technology to phaco such as N eosonix and Aqualase, which, though able to reduce the energy required to remove a cataract, were only able to engage surgeons’ interest temporarily. So it seems that the prospect of being able to perform a consistent, more accurate capsulorhexis is the maj or technical benefit of this new procedure. It has been claimed that a femto-rhexis would improve safety, but there have been reports of rhexis tears due to unforseen tags and even dropped nuclei due to capsular block phenomenon during hydrodissection. These complications could be minimized as surgeons become more familiar with how to apply this technology. The hope is that a more consistent rhexis will improve refractive outcomes and theoretically this could indeed be correct. A method which creates a rhexis with a consistent size and shape is likely to result in less variation in the axial position of an implant and therefore a more predictable effective lens position of the intraocular lens (IOL). N evertheless there is considerable noise in predicting refractive outcomes. IOLs are typically labelled in 0.5-diopter increments and the accuracy of refraction is in the range of a quarter diopter. It may prove difficult, therefore, to demonstrate the improved accuracy which is likely to be less than 0.25 D in prospective studies. Despite these cautions, the option of laser technology to remove cataracts has quite widespread appeal both to surgeons and patients. The issues which still need to be addressed are economic, the cost-effectiveness of the procedure. At present this entails a significant capital outlay as well as on- going consumable costs and procedure fees. I suspect that strategies will become apparent to address these issues and femtosecond cataract surgery will be more widely performed in the future. I do believe it is wise for surgeons to have a clear understanding of the technical as well as socioeconomic issues in deciding whether the time is right to consider moving to femtosecond cataract surgery or perhaps wait until some of these issues are addressed. Finally, I would like to extend a personal invitation to our readers to j oin us for our 25th APACRS Annual Meeting to be held in conj unction with the 14th Congress of the Chinese Cataract Society to be held in Shanghai from 31 May to 3 J une 2012. Shanghai is the ideal place to explore our theme of “The Sophisticated Surgeon - Elegant, Efficient, Excellent”, reflecting the city’s own level of sophistication. See you in Shanghai! Warmest regards Graham Barrett, MD President, APACRS Chief Medical Editor, EyeWorld Asia-Pacific Dear Friends I t gives me great pleasure to write the editorial for this interesting issue, as we peep into the future to find out what lies ahead. Seven articles constitute the cover feature of the present issue, with contributions from all over globe. While we make our way to target 2020, some revolutionary innovations are awaiting penetration into ophthalmic practice. Many premium intraocular lenses have been enj oying their establishment in European market. European surgeons have a wider range of intraocular lenses compared to surgeons in the U.S. as the latter look forward to FDA approval. This issue also addresses the important subj ect of aligning toric intraocular lenses as well as the scope of implantable miniature telescopes for AMD. Technology has always influenced ophthalmology more than any other medical fraternity. The femtosecond laser is one such phenomenal advancement in ophthalmic technology. After changing the outlook of laser refractive surgery, it is infiltrating cataract surgery despite the logistics involved. It seems to add precision and obj ectivity to every form of ophthalmic surgery. Femtosecond laser-assisted keratoplasty is one such example. KAMRA corneal inlay, corneal collagen crosslinking, and presbyopia surgery are constantly gaining the attention of modern day ophthalmic surgeons. Amidst these fascinating innovations, the art of our very own extracapsular cataract extraction is threatened to extinction. Moving on to retina; important issues like cystoid macular edema, clinically significant macular edema, the role of anti-VEGF and pseudophakic retinal detachment are discussed. The software revolution in ophthalmology has helped surgeons immensely as far as preoperative evaluation as well as intraoperative and postoperative outcome is concerned. And we must all thank Steve J obs for his contribution to technology which can now be applied to ophthalmology for precise evaluation and treatment. I hope these excellent discussions make great reading for all and conclude with: T h in k lof t y t h ou g h t s alw ays; in su ch a con t ex t ev en if you f ail Y ou r Asp irat ion s k eep you on a h ig h er p lan e - T h iru k k u ral 5 9 6 Warmest Regards, S. N ataraj an, MD Regional Managing Editor EyeWorld Asia-Pacific