July 2015




Femto cataract clinical update

Embracing femto

by Ellen Stodola EyeWorld Staff Writer


I think everyone feels like whatever theyre doing is the best thing and the right thing, and were always reluctant to incorporate new technology. Theres always a hesitation of Do I need it and is it worth the price? Richard Lewis, MD

Doctor's consultation

When integrating new technology like the femtosecond laser for cataract surgery into a practice, some surgeons will be bigger proponents than others.

Surgeons discuss their initial skepticism about femto and how theyve embraced the technology

With every new technology, there are potential benefits, but there is also the potential for a learning curve and concerns about adopting it into practice. Richard Lewis, MD, Sacramento Eye Consultants, Sacramento, Calif., and Henry Perry, MD, Ophthalmic Consultants of Long Island, Rockville Centre, N.Y., spoke about their initial hesitations with the femtosecond laser, adopting it into their practices, and how they view it today.

I think everyone feels like whatever theyre doing is the best thing and the right thing, and were always reluctant to incorporate new technology, Dr. Lewis said. Theres always a hesitation of Do I need it and is it worth the price? This mindset can be applied across a number of spheres, including the practice of ophthalmology. I think theres always that human nature of hesitancy and justifying cost for new technology, he said. However, as new technologies integrate into practices, the value they bring often becomes clear.

Why the original skepticism?

In this case, the femto laser has a level of precision and safety that is unparalleled, Dr. Lewis said, and he thinks that in the next 1015 years, all cataract surgery will be done with the laser. He likened the transition to a number of other changes throughout his career, like the transition from intracap to extracap to phacoemulsification. Each of these was met with resistance, Dr. Lewis said, and each time, a number of people didnt want to make the change. [With femto] we had to do a certain number of cases to justify the cost, and we were concerned about whether we could do that, he said. Out of his 10-surgeon practice, some were bigger proponents than others for the technology.

Dr. Perry was skeptical to begin with because he didnt see the need for the technology. Because cataract surgery is already a successful surgery, he did not see the value that the femtosecond laser would create for the everyday practice. However, as one member of the surgery center, he was outvoted, and the practice acquired a LenSx laser (Alcon, Fort Worth, Texas). During the first week with the new laser, Dr. Perry said that 2 of the best surgeons in the 50-surgeon practice both lost nuclei on not difficult cases. This caused him to think even more about the issues with the laser, but he realized that there would naturally be some problems during the initial introduction of new technology and that he should at least give it a chance.

What changed your mind?

When Dr. Perry first began using the femtosecond laser, he started doing relaxing incisions on corneal transplant patients to become more familiar with the instrument. I saw that you could do superb relaxing incisions with it, he said. The laser could go right inside the graft margins, and it was programmable to 80% depth. Then he started using the laser for patients who had high astigmatism. Dr. Perrys first case with the LenSx was a divide and conquer that he programmed into the machine. However, he noted that in his first 4050 cases, the capsulorhexis was not complete, so he had to go in manually and make sure there were no edges. A later software correction helped to fix this and make the openings more consistent.

After switching machines to a Catalys laser (Abbott Medical Optics, Abbott Park, Ill.), Dr. Perry really got on board because he said the machine had very few problems. He compiled his surgical outcomes and incidence of complications in his first 152 cases with the LenSx and Catalys and only had 2 complications. I compared this to what I had been doing, and I felt that there was a significant difference, he said.

I think its one of those things that makes good surgeons better, and I think it makes average surgeons better, Dr. Lewis said. The femtosecond laser can help enhance results, and he believes the data is beginning to show more and more that there is improved safety with this technology.

How has femto changed your practice?

Patients like new technology, Dr. Lewis said. They want to go to the person with the latest technology. So the femtosecond laser helps to create a positive buzz in the practice.

Over the past 3 years of using the femtosecond laser, Dr. Perry said he feels its safer than doing a manual capsulorhexis because its done in 1.3 seconds under suction. It makes sense that its superior to doing a manual capsulorhexis that may take 20 seconds or longer and has more opportunity for error, he said. I tell the exact same thing to my patients, he said. I feel its a safer procedure and I have better success with it. Dr. Perry said that another aspect that helps with the ease of femtosecond laser surgery is having someone to operate the laser. In his practice, a fellow does this, and it helps improve the surgical flow, he said.

How to talk to patients about it

Dr. Lewis said that if a patient comes in for cataract surgery, he or she will get information on the femtosecond laser and other options. Technicians do a complete exam, and while the patient is dilating, he or she watches a video of different options, including laser options for treating astigmatism. Dr. Lewis is using the femtosecond laser on about 20% of his cataract patients now.

Editors note: Drs. Lewis and Perry have no financial interests related to this article.

Contact information

: rlewiseyemd@icloud.com
Perry: hankcornea@gmail.com

Related articles:

Femto laser-assisted cataract surgery with ICL in situ by Douglas Grayson, MD, FACS

10 pearls for transitioning to femtosecond laser-assisted cataract surgery by Ellen Stodola EyeWorld Senior Staff Writer

Femtosecond laser cataract surgery innovations

Why not femto? by Faith A. Hayden EyeWorld Staff Writer

Review of Effect of femtosecond laser-assisted cataract surgery on the corneal endothelium

Can the femto for cataract live up to its hype? by Michelle Dalton EyeWorld Contributing Writer

Femtosecond mini-bubble technique by Roger F. Steinert, MD

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