BLOG: Laser system offers next-level astigmatism management
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Anyone who has performed femtosecond laser-assisted cataract surgery can attest to the precision of incision placement, intrastromal toric marks and capsulotomy centration.
However, one of the limiting factors in the precision of our surgical outcomes, particularly when it comes to astigmatism management, has been the manual comparison of many different keratometry measures, plugging those into various calculators and nomograms, and translating the results into a surgical plan.
The wave of the future, it seems clear, is more automated and more integrated surgical planning. Just about every manufacturer, including Johnson & Johnson, Alcon, Zeiss and Lensar, have introduced some of these digital planning tools, although there is wide variety in how smoothly integrated they are and which specific devices can be linked or integrated. For example, some systems provide customizable integration of surgical planning data but require the user to also have the brand’s operating microscope to get the full benefit of the software.
As a long-time user of the Catalys system (Johnson & Johnson Vision), I’ve recently been able to integrate Cassini Ambient measurements into the Catalys, with an incredibly positive impact on astigmatism planning. The patient’s demographics, corneal measurements (including total corneal astigmatism, or TCA) and iris registration (IR) are automatically populated in the appropriate fields for the laser, and this preoperative information is readily accessible during treatment. Catalys compares the undilated IR data from Cassini to its own dilated IR image and, within just a few seconds, confirms a strong match between the two. The preoperative data are used to identify the correct position of the steep axis, after which the laser creates tiny intrastromal radial marks or places the arcuate incisions.
The Donnenfeld arcuate incisional nomogram is integrated into the system, which further streamlines my decision process for incisional correction of astigmatism. And, because TCA data are already included, I don’t need to use the Koch formula to compensate for posterior corneal astigmatism. This saves time planning and calculating.
Sitting at the laser, I have all this information at my fingertips. I can choose to accept the treatment plan, modify it or revert to a preoperative arcuate plan, if I wish. While I don’t yet have data on the time spent or refractive accuracy, I am confident that this integrated approach will be both more efficient and more accurate. I am excited at the direction that surgical planning is headed and believe we can look forward to more developments like this from the manufacturers of our diagnostic tools and FLACS software.
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