Safety and effectiveness of cataract surgery continue to improve, thanks to ongoing innovations.
Looking back over the past year and into the near future, Eric D. Donnenfeld, MD, Robert H. Osher, MD, and Mark Packer, MD, spoke to Ophthalmology Times about developments in diagnostic products and other tools used in cataract surgery. In addition, they discussed combination microinvasive glaucoma surgery (MIGS) and office-based surgery as new trends.
Femtosecond laser update
Femtosecond laser-assisted cataract surgery (FLACS) remained a topic for debate in 2016.
Dr. Packer, clinical associate professor of ophthalmology, Oregon Health & Science University, Portland, said there is still no compelling evidence that the benefits of FLACS are significant enough to justify the cost. Discussing the various functions of the laser, Dr. Packer acknowledged that its use for lens fragmentation is advantageous in dense cataracts for reducing ultrasound energy use. However, the laser’s value for this application is limited in the United States where most cataracts are grade 2+ or less.
For capsulotomy, there is no question that the femtosecond laser outperforms a manual technique in terms of creating a more precisely sized, shaped, and centered capsule opening. However, controversy continues over the strength of the laser capsulotomy edge.
To date, one of the best studies investigating this issue was published in 2016 [Thompson VM, et al. Ophthalmology. 2016;123(2):265-274], Dr. Packer said. It compared edge tear strength of capsulotomies created with a femtosecond laser (LenSx, Alcon), manually, and using an investigational thermal-based device (Zepto Capsulotomy System, Minosys) and found the capsulotomies created with the thermal technology had significantly greater edge strength than those made with the laser or manually.
The laser is also very effective for making the corneal incisions for cataract surgery, Dr. Packer noted. Nevertheless, many surgeons still use a blade because it is quicker and more reliable, especially in eyes with arcus senilis that can be hard to cut through with a laser.
“I think in the future, the value of the femtosecond laser will be realized through its integration with preoperative diagnostics to guide astigmatic correction through arcuate incisions or for placing a reference mark for toric lenses,” he said.