Analyses of data from eyes undergoing cataract surgery using an image-guided femtosecond laser (LenSx, Alcon) to automate corneal incisions, capsulorhexis, and phacoemulsification show benefits for better safety and efficacy outcomes compared with historical control groups operated on with standard techniques.
Femtosecond laser improves outcomes in refractive cataract surgery
Chicago — Early experience with an image-guided femtosecond laser (LenSx, Alcon Laboratories) suggest it has promise for improving the safety and efficacy of refractive cataract surgery, said Stephen G. Slade, MD, at the annual meeting of the American Academy of Ophthalmology.
Dr. Slade reported results for a series of refractive cataract surgery cases he performed using the femtosecond laser for capsulotomy, lens photolysis, and corneal incisions. Compared with various historical control groups operated on with conventional surgical techniques, the eyes undergoing the femtosecond laser-assisted procedure achieved superior outcomes for a variety of standard outcome measures.
“Patients who choose refractive cataract surgery are expecting to undergo a procedure that is safe and effective in allowing them to see well without glasses. However, using visual acuity outcomes after LASIK as a benchmark, we would have to say there is a need to improve the effectiveness of refractive cataract surgery. Furthermore, Marketscope data indicate that only about one-fourth of the 8,600 cataract surgeons in the US consider themselves refractive cataract surgeons,” said Dr. Slade, private practice, Slade & Baker Vision, Houston, TX.
“Based on our outcomes with the image-guided femtosecond laser, I believe this advanced technology will allow us to confidently deliver the results our patients are expecting and encourage more surgeons to expand into the realm of refractive cataract surgery.”
Results from a comparison of capsulotomy outcomes showed that use of the femtosecond laser versus a manual technique enabled creation of capsulotomies of more exact dimension, shape and centration, and this performance translated into excellent refractive and visual acuity outcomes. Dr. Slade reported that in a series of 60 cases performed with manual capsulorhexis, the achieved diameter was within 0.25 mm of intended in only 10% of eyes versus in nearly all cases performed with the femtosecond laser.
Among 50 eyes that underwent femtosecond laser-assisted cataract surgery with implantation of an accommodating IOL, day 1 BCVA was 20/25 or better in about 80% of eyes and the spherical component was within 0.5 D of intended in about 75%. Consistent with these outcomes, there was much less variability in the effective lens position (ELP) for procedures performed using the femtosecond laser versus with a manual capsulorhexis, and considering SEQ outcomes at 3 months, the refractive predictability measured by standard deviation from the intended SEQ [CORRECT?yes] was also better for the cohort operated on with the femtosecond laser (0.40 D) versus in four groups of historical controls (0.52 to 0.60 D) with less scatter.
“Our premise is that by standardizing the capsulorhexis we can also standardize the ELP. ELP remains a significant source of IOL power error as well as induced coma and astigmatism because the size of the capsulorhexis and its shape affects capsule contraction and consequently IOL position and tilt,” said Dr. Slade.
“With much tighter accuracy in our SEQ outcomes, we will be able to put more refractive cataract surgery patients in the bucket of not having to wear glasses.”
Dr. Slade noted that cataract surgery safety outcomes also fall short of LASIK, but the femtosecond laser is showing potential for driving better safety.
“Compared with eyes undergoing standard surgery, those operated on using the femtosecond laser for lens fragmentation or liquefaction benefited with more than a 50% reduction in phaco time and power and a 60% reduction in endothelial cell loss. We can also imagine this no-touch capsulotomy technique will have a particular advantage for improving safety in complicated cases, such as eyes with a traumatic cataract or pseudoexfoliation,” said Dr. Slade.
Practical issues
Dr. Slade noted he faced a learning curve in implementing the femtosecond laser into his practice, including not only in becoming adept with the technical aspects of performing the procedure but also in terms of how to describe it to patients, what to charge, and how to manage patient flow. However, from the patients’ perspective, this premium procedure has been very well-received.
“I have never seen a technology that patients more readily grasped and opted for. Just from the first mention of ‘laser cataract surgery’, patients were ready to sign up,” said Dr. Slade.
Dr. Slade is a consultant to Alcon.
Eye Doctor Arizona – Dr. Warren Hill is a board certified ophthalmologist, world renown eye doctor for IOL power calculations and premium lens implants in Mesa, Arizona.
Tags: Cataract, Cataract Surgeons, Cataract Surgery, Intraocular Lens, LASIK, Ophthalmology, Refractive Cataract Surgery
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