EyeWorld Asia-Pacific September 2014 Issue

39 EWAP CATARACT/IOL September 2014 by Vanessa Caceres EyeWorld Contributing Writer Femtosecond laser advantages for cataract surgery evolving Ever-changing technology requires continuous study I dentifying the clinical advantages of femtosecond laser refractive cataract surgery is like shooting at a moving target, as research studies in this hot area of cataract surgery continue to emerge. A PubMed search of the term “femtosecond laser cataract surgery” yielded 287 results in mid May. Surgeons speaking at the 2014 ASCRS•ASOA Symposium & Congress in Boston touted what the research shows but also where it still lacks. “It depends on what outcomes you’re tracking,” said William W. Culbertson, MD , professor of ophthalmology, director of the cornea and refractive surgery services, and the Lou Higgins chair of ophthalmology, Bascom Palmer Eye Institute, Miami, Fla., U.S. “If you look at visual acuity outcomes or safety outcomes, the results of laser cataract surgery compared to manual phaco are similar, largely because the results and safety of routine surgery are so good anyway. However, most surgeons who have used the lasers and who have done enough cases to make it through the learning curve for the laser are convinced that it makes the surgery easier and more precise.” Refractive outcomes Some refractive advantages with the use of the laser have emerged in the existing studies, surgeons said. “What we do know is that refractive laser-assisted cataract surgery causes less endothelial cell loss, better IOL centration, and less decentration over time,” said Jonathan H. Talamo, MD , associate clinical professor of ophthalmology, Harvard University, Boston, Mass., U.S. “All the markers that we look for such as lower phaco energy, less endothelial cell loss, precision of capsulotomy diameter, shape, position, and precision of the relaxing incision depth, and arc length have been well-documented in the literature,” Dr. Culbertson said. “To say that the laser does not help would be to say that these important parameters don’t matter and would fly against many of the basic assumptions that we’ve made over 40 years using phaco small- incision cataract surgery.” Ronald Krueger, MD , Department of Ophthalmology, Cleveland Clinic, Cleveland, Ohio, U.S., said that astigmatic incisions created with the femtosecond laser are shown to offer an advantage because they are more controlled and performed with laser precision. “It makes sense that they would be better than a blade. In terms of depth and length of the incision, they can be more titratable,” he said. That’s in contrast to the primary incision, which can likely be cut to the same size with either a keratome or a laser, Dr. Krueger said. “I know surgeons who use the blade because it doesn’t make much difference,” he said. Another area with emerging evidence is the laser’s ability to create a capsulorhexis that is perfectly centered and sized to allow for better prediction of effective lens position, Dr. Krueger said. The data in this area are not yet conclusive, he said. However, in a presentation at the 2014 ASCRS•ASOA Symposium & Congress, Brendan Vote, FRANZCO , Launceston, Australia, Comparative precision of a manual blade vs. laser incision. Depth, orientation, and length are more predictable and titratable with a laser, and will give a greater and more accurate effect than a manual blade, some surgeons believe. Source: Eyemaginations continued on page 41 AT A GLANCE • Emerging evidence indicates that femtosecond laser refractive cataract surgery has some refractive advantages over phacoemulsi cation, including the creation of astigmatic incisions and less endothelial cell loss. • Femtosecond laser refractive cataract surgery needs long- term, randomized trial data and studies to demonstrate bene t over traditional phaco. • Studies still need to conclusively show the advantage of lasers in complicated cataract cases. Anecdotally, surgeons will use the laser in these patients, but the small number of complicated cases makes it a dif cult area to formally study. • Lasers will continue to improve, leading to re ned outcomes.