EyeWorld India March 2014 Issue

21 EWAP CAtArACt/IOL March 2014 by Michelle Dalton EyeWorld Contributing Writer Can femtosecond lasers live up to the hype? A panel discussion during the American Academy of Ophthalmology meeting suggests they can C ombining femtosecond laser with intraoperative aberrometry results in a much higher percentage of eyes within 0.5 D of emmetropia than manual procedures, can virtually eliminate the need for ultrasound in all but the most dense of cataracts, and does not induce additional inflammation in the eye, according to three experts speaking on the topic at the 2013 American Academy of Ophthalmology meeting in New Orleans. refractive target accuracy Over the years, published studies have verified the effectiveness of cataract surgery, but the literature shows only around 50% of eyes are within 0.5 D of predicted refractive targets (with ranges of 46%-55% within 0.5 D), said Bret L. Fisher, MD , medical director, Eye Center of North Florida, Panama City, Fla., U.S. Dr. Fisher’s group wanted to determine the impact of intraoperative aberrometry on uncorrected visual acuity and predictability in femto laser cataract surgery, so they retrospectively reviewed consecutive cases that had cataract surgery with IOL implantation using the LenSx (Alcon, Fort Worth, Texas, U.S.) without intraoperative wavefront aberrometry (Group 1). Group 2 comprised consecutive cases that had cataract surgery with IOL implantation using the LenSx with ORA intraoperative wavefront aberrometry (WaveTec Vision, Aliso Viejo, Calif., U.S.). Baseline demographics were fairly well matched between the two groups, and there were no statistically significant differences between the number of patients who received monofocal, multifocal, or toric lenses, he said. “This was really representative of the typical makeup of our patient population,” he said. Evaluating eyes targeted solely for distance with the femtosecond laser, “about 90% of our patients were achieving the 20/40 benchmark, which was high,” he said. “About half achieved 20/25 uncorrected distance vision.” In the group with both the femto and intraoperative aberrometry, 100% of the patients achieved 20/40 and about 73% achieved 20/25 UCVA, “and if we look at the benchmark statistic used to judge accuracy, about 80% were now achieving this level of accuracy as opposed to 50%–55% in the earlier studies,” he said. Right before AAO, Dr. Fisher conducted a small study using the latest generation ORA technology, and had 88% of patients within 0.5 D, he said. “We’re approaching 90% of our patients achieving refractive outcome accuracy with the newest technologies that we have available compared to the 50% or so we’ve been able to achieve in the past,” he said, predicting those numbers will rise to even greater accuracy. Equally safe? Many say femtosecond-assisted laser cataract surgery is here to stay, but some naysayers question the safety of the laser itself. Femtosecond lasers have been commercialized for more than a decade, and the safety factor in refractive surgery is well known. A prospective, contralateral, randomized study enrolling 32–35 patients (the study is ongoing) with very strict inclusion and exclusion criteria was undertaken to try and address the safety component of the femto laser in cataract surgery, said Mike P. Holzer, MD , vice chairman and director of refractive surgery, Department of Ophthalmology, University of Heidelberg, Germany. “Suffice it to say, these were very healthy eyes aside from the cataract,” he said. The group evaluated several postoperative and intraoperative parameters, including visual acuity, intraocular pressure (IOP), cell and flare, effective phaco Full fragmentation of the lens. Source: Tim Schultz, MD, and H. Burkhard Dick, MD continued on page 24