August 2014




Reviewing phaco fundamentals: How to optimize settings for routine and complex cases

by David F. Chang, MD


EyeWorld logoSupplement to EyeWorld August 2014

Phaco fundamentals: Device settings and best practices for routine to complex phaco-emulsification

This CME supplement is supported by unrestricted educational grants from Alcon and Bausch + Lomb.

David F. Chang, MD

David F. Chang, MD

Optimizing machine settings is an important factor in successful cataract surgery, but it is often overlooked or underemphasized in phaco education. The 2013 ASCRS Clinical Survey confirmed strong educational interest in this topic for a majority of cataract surgeons, regardless of their experience.

Like the simplicity of a point-and-shoot camera, using the same phaco machine settings throughout every case might at first seem appealing. However, because the ultrasound power and fluidic objectives change between the different stages of nuclear emulsification, modifying these settings can improve both surgical efficiency and safety. Thanks to multiple, preprogrammed memory settings, surgeons can now use the foot pedal to seamlessly alter these parameters intraoperatively. Much as cameras allow you to choose preconfigured settings for sports, portrait, or nighttime photography, we can preconfigure a package of settings for sculpting, chopping, fragment removal, or epinucleus aspiration.

Finally, understanding certain principles and objectives allows us to further alter and optimize our phaco machine parameters for more complicated cases, such as those with weak zonules, brunescent nuclei, or IFIS. This EyeWorld educational program highlights key principles for optimizing fluidics and power modulation for different stages of nuclear removal in both routine and complicated cases. Additional information, lectures, and my most recent textbook chapter on this subject can be found in the ASCRS Phaco Fundamentals Classroom at You can access this online classroom for free.

Dr. Chang is clinical professor of ophthalmology, University of California, San Francisco. He can be contacted at

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Society of Cataract & Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accredited by the ACCME to provide continuing medical education for physicians.

Educational Objectives

Ophthalmologists who participate in this course will: Describe platform-specific phaco settings to establish a baseline to customize settings in practice;

Discuss and integrate best practices and phaco techniques for routine cataract surgery, including nuclear disassembly, hydrodissection, efficient use of fluidics and phaco power; and Establish best practices for successfully navigating common phaco complications and surgical challenges.

Designation Statement

The American Society of Cataract & Refractive Surgery designates this live educational activity for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity.

Claiming Credit

To claim credit online, participants must visit to review content, complete the post-activity test, and credit claim. All participants must pass the post-activity test with a score of 75% or higher to earn credit. Alternatively, the post-test form included in this supplement may be faxed to the number indicated for credit to be awarded, and a certificate will be emailed within 2 weeks. When viewing online or downloading the material, standard internet access is required. Adobe Acrobat Reader is needed to view the downloaded materials. CME credit is valid through January 31, 2015. CME credit will not be awarded after that date.

Notice of Off-Label Use Presentations

This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses only.

ADA/Special Accommodations

ASCRS and EyeWorld fully comply with the legal requirements of the Americans with Disabilities Act (ADA) and the rules and regulations thereof. Any participant in this educational program who requires special accommodations or services should contact Laura Johnson at or 703-591-2220.

Financial Interest Disclosures

David F. Chang, MD, has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, Clarity Medical Systems, LENSAR, and Transcend Medical, and is a member of the speakers bureau of Allergan. He has an investment interest in Calhoun Vision, Clarity Medical Systems, ICON Bioscience, LENSAR, Mynosis, PowerVision, and RevitalVision, LLC. Dr. Chang earns royalties or other financial gain from Ocular Surgery News/SLACK.

Kenneth Cohen, MD, has no ophthalmic- related financial interests.

Bonnie An Henderson, MD, has received a retainer, ad hoc fees, or other consulting income and travel reimbursement from: Alcon Laboratories and Bausch + Lomb. She has received research support from Bausch + Lomb.

Lisa Park, MD, has no ophthalmic-related financial interests.

Staff coordinators Brad Fundingsland and Laura Johnson have no ophthalmic-related financial interests to disclose.

Reviewing phaco fundamentals: How to optimize settings for routine and complex cases Reviewing phaco fundamentals: How to optimize settings for routine and complex cases
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