EyeWorld India June 2013 Issue

21 June 2013 EWAP FEAturE LenSx Laser Source: Alcon A new twist on femtosecond platforms Diving into the debate on combined versus dedicated cataract units F emtosecond lasers have become an accepted part of the LASIK lexicon and now are making inroads into the cataract arena as well, according to Seba Leoni, vice president, global franchise head, cataract, Alcon, Fort Worth, Texas, USA/Hünenberg, Switzerland. “Approximately 80% of LASIK procedures in the U.S. are done with a femtosecond laser,” he said. Likewise, femtosecond cataract surgery is now on the upswing. In addition to femtosecond units dedicated to cataract use, two out of four of these lasers, the Victus (Bausch+Lomb, Rochester, NY, USA) and the LenSx (Alcon), have regulatory approval to do both LASIK flaps and lens-related procedures using one system. The question is, can these combination units measure up to their cataract- dedicated counterparts? Scoring the combination entry Calvin W. Roberts, MD , chief medical officer, Bausch+Lomb, thinks combination femtosecond systems do have the capability to deliver in both the cataract and the corneal realms. However, he offers a caveat—“only if it is a great laser with a great patient interface,” he said. To perform a good cataract procedure with a femtosecond laser, he pointed out, you have to be able to get exquisitely good focus on the anterior capsule and within the lens, without any distortions coming from the cornea. “Therefore, the way that you can ideally dock the laser to the cornea for a cataract procedure is to have a fluid interface between by Maxine Lipner EyeWorld Contributing Writer AT A GLANCE • New combination femtosecond lasers are designed to perform cataract surgery as well as cut LASIK flaps and more. • Proponents claim that these lasers can help practitioners save space and cut costs. • Opponents, however, argue that with these systems, tradeoffs in logistics and quality must be made. the laser and the cornea so that there’s no contact to the cornea that could create folds or other distortions,” Dr. Roberts said. For femtosecond cataract surgery the Victus uses almost a 100% liquid- filled interface, he said. “[It doesn’t] require high vacuum in order to hold it in place because it’s not creating distortion,” he said. By contrast, to cut a corneal flap, 100% applanation of the interface against the cornea with high suction is needed. “You need no fluid,” Dr. Roberts said. “You want the laser right against the cornea because what you need is accuracy down to about 4 microns, and you don’t get that if you don’t have the laser right against the cornea.” Accordingly, the Victus platform offers two settings in one patient interface—a low vacuum, liquid one for cataract procedures, and a high vacuum, sans liquid interface for corneal cutting. Currently in the U.S. the Victus is approved for cutting corneal flaps as well as cataract capsulotomy. In addition, one new application that the Victus just received 510 clearance for in February is the creation of penetrating arcuate incisions in the cornea, something that study results indicate can offer a higher degree of precision. 1 LensAR Laser System Source: LensAR continued on page 22