The future of femtosecond laser
Dr. Donnenfeld believes that with the improvements that have occurred over the years, femtosecond laser-assisted cataract surgery (FLACS) offers benefits for lens disruption and for creating more precise arcuate incisions, intrastromal incisions that cannot be performed manually, and more precise capsulotomies.
“As a new development this year, it was shown that the laser can make primary incisions with reverse sidecuts that self-seal better than keratome incisions,” Dr. Donnenfeld said.
Dr. Packer said the past 8 years in cataract surgery can be described as “the rise and fall of the femtosecond laser.” Keranova, a startup company in France, is working to develop a femtosecond laser for cataract surgery. The major existing manufacturers did not introduce any significant upgrades to their systems in the past few years, and only the two smaller manufacturers, LENSAR and Ziemer, seem to be showing any recent growth in sales, Dr. Packer said.
Still, Dr. Packer said he is not sure if the situation with FLACS should be viewed as the smoldering embers at the end of the campfire or if there will be a spark that will re-ignite the flames.
“In retrospect, we can say that the early critics of FLACS who raised concerns about anterior capsule tears and noted lack of improvement in functional outcomes swayed the market,” he said. “The technology may also have been a victim of the times, considering it was launched during an economic period when people were very cost-conscious.”
In October, Johnson & Johnson Vision received FDA clearance for the mobile patient bed for its Catalys Precision Laser System. The new bed is designed to optimize surgical workflow and integrates with the laser through Bluetooth connectivity.
LENSAR continued to expand integration between preoperative diagnostics and the femtosecond laser. In June 2017, it announced receiving FDA 510(k) clearance for the wireless integration of its laser with the Pentacam HR and Pentacam AXL tomographers (both from Oculus). The integration uses the Streamline III software from LENSAR and allows guidance of astigmatic incisions using the Pentacam parameters.
In November, LENSAR announced FDA clearance of Streamline IV, which includes capsular marks for orientation of toric IOLs based on iris registration from Cassini (iOptics), Pentacam, Aladdin (Topcon), or the OPD Scan (Nidek).