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Speakers debate merits of femtosecond vs. manual phaco
CHICAGO — Femtosecond laser-assisted cataract surgery has distinct upsides and downsides, according to two speakers who addressed colleagues here.
Burkhard Dick, MD, PhD, and Michael E. Snyder, MD, debated the merits of laser refractive lens surgery during the Refractive Subspecialty Day preceding the American Academy of Ophthalmology meeting. Dick explained the procedure’s pros and Snyder described the cons.
According to Dick, femtosecond laser-assisted surgery is faster than manual phacoemulsification in creating the corneal incision, performing the capsulorrhexis and fragmenting the lens. Study results showed that the complete procedure took about 6 minutes, Dick said.
“The incisions are definitely better than manual,” he said. “Nobody would be able to make intrastromal incisions, for example . . . There is no need for [stromal] hydration.”
Capsulotomy typically takes about 0.7 seconds to perform. Additionally, femtosecond laser capsulotomies are more circular than manual capsulotomies, according to Dick.
Femtosecond laser-assisted cataract surgery also results in less trauma and less deviation from targeted correction than manual cataract surgery, Dick said.
Snyder pointed out that, in his practice, patients must be moved to another room where the laser is located, adding total time to the procedure. Furthermore, docking the laser to the patient’s eye is time-consuming and stressful for the patient and surgeon, he said.
Additionally, Snyder said that some laser-created incisions end up needing to be opened manually.
Capsulorrhexis creation requires programming, which adds about 24 seconds to the procedure.
According to one study, femtosecond laser-assisted cataract surgery took 190.6 seconds, whereas manual surgery took 75.3 seconds, Snyder said.
In addition, manual surgery is more cost-efficient than femtosecond laser surgery in terms of quality-adjusted life years, according to Snyder.
Disclosures: Dick is a consultant for Abbott Medical Optics, Aquesys, Bausch + Lomb, an equity owner in Calhoun Vision, and receives patent royalties from Morcher GmbH and Oculus. Snyder is a consultant for Alcon, Haag Streit and Humanoptics.