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Speaker: Image-guided femtosecond cataract surgery improves refractive outcomes
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CHICAGO — Use of an image-guided femtosecond laser enhanced the safety and effectiveness of cataract surgery and IOL implantation, a surgeon said here.
Stephen G. Slade, MD, FACS, presented preliminary findings from the first 50 accommodating IOLs implanted with image-guided femtosecond laser technology during Refractive Subspecialty Day preceding the joint meeting of the American Academy of Ophthalmology and the Middle East Africa Council of Ophthalmology.
"The whole focus of femtosecond cataract surgery is to improve the effectiveness of cataract surgery," Dr. Slade said. "You can do whatever you can dream of as long as the engineers have programmed [the laser]." Investigators used an image-guided LenSX femtosecond laser (Alcon) to perform multi-planar corneal incisions, capsulorrhexes and lens fragmentations before implantations of accommodating IOLs.
Results showed that 92% of eyes had best corrected visual acuity of 20/30 or better at 1 day after surgery and 100% of eyes had BCVA of 20/30 or better at 1 week.
Perfectly-shaped and sized capsulorrhexes enhanced effective lens position and IOL-capsule overlap, Dr. Slade said.
Dr. Slade noted that of 80,600 cataract surgeons, about one-quarter consider themselves cataract-refractive surgeons. Image-guided femtosecond cataract surgery will help cataract surgeons optimize refractive outcomes, he said.
The take-home message of this study is that precision imaging (OCT or 3-D confocal structured illumination) coupled with a precision cutting tool (femtosecond laser) can enhance the way we do surgery, especially refractive cataract surgery, in which a specific refractive outcome is desired. With the advent of premium channel IOLs to enhance the refractive outcomes of patients desiring “glasses free” vision, the accuracy of effective IOL position and centration has become critical in meeting this endpoint. We have seen major advances in the optical refinement of IOLs and in the IOL power calculations, while the surgical procedure itself has only seen smaller incremental improvement since the advent of phacoemulsification several decades ago. An image-guided femtosecond laser represents a major advance in the surgical procedure and offers the potential for an ideal capsulotomy size, shape and centration every time and enhanced safety in performing nucleus fragmentation. Few individuals would criticize the safety and surgical precision of this technology. Rather, the question some might have is regarding cost and reimbursement. We look forward to the implementation of this technology in the market and how the market dynamics will answer the question of cost and reimbursement.
– Ronald R. Krueger, MD
Cleveland