Symposium addresses patient expectations with new technologies

Meeting patient expectations with new technologies in corneal and lenticular refractive surgeries was the theme of a Saturday afternoon symposium, sponsored by Advanced Medical Optics (AMO) and moderated by Carlos Verges, MD, of Spain.

Gustavo Tamayo, MD, of Colombia, began the symposium by presenting the indications and contraindications of a laser treatment with CustomVue and iris registration. After explaining how iris registration works, Dr. Tamayo talked about the changes that occur in high-cylinder treatments (cyclotorsion and pupil centroid shift) and how to compensate for them.

James Mustri, MD, of Mexico, continued the laser treatment discussion by offering some pearls for the treatment of presbyopia with a particular excimer laser (VISX S4) and iris registration. He pointed out the etiology of presbyopia and how it related to the aging eye.

Dr. Mustri also presented his case results involving 100 patients who were corrected for presbyopia with the CustomVue technology and iris registration. He also stressed the importance of patient selection and proper preoperative evaluation.

Eduardo Alfonso, MD, of the United States, turned the discussion to the femtosecond laser (IntraLase) and its use in corneal surgery. Dr. Alfonso outlined some of the surgical uses for the laser in selective keratoplasty procedures.

He showed several videos of how the laser is used in anterior lamellar keratoplasty, paired arcuate keratotomies, creating intracorneal ring channels, and top-hat-shaped penetrating keratoplasty (PK). Dr. Alfonso concluded his presentation by saying with his 3 years of experience, he has found the femtosecond laser to provide good clinical results and a solid safety profile. The laser has excellent functionality and is an innovative platform for future applications, he said.

Ramon Naranjo Takman, MD, of Mexico, presented his experiences with shaped incisions created with the femtosecond laser during PK. He shared his main concerns in performing PK, including the quality of tissue attained, specific risks for all indications, precise diameter and edges (both donor and recipient), damage generated to the tissue during surgery, and scar strengths that can assure safety for the patient's lifestyle.

Dr. Naranjo Takman then presented the various shaped incisions that can be performed for PK with the femtosecond laser, including the top hat, mushroom, standard, zig zag, Christmas tree, and zig square. He concluded with a video of his experience performing PK with the laser.

Perry Binder, MD, of the United States, and medical director for IntraLase, presented his experiences with the femtosecond laser and outlined information and capabilities of the unit. In LASIK, the laser performs flap creation, improves flap predictability, it is insensitive to corneal thickness and curvature, and more than 1 million procedures have been performed with 475 lasers in the field.

Dr. Binder said new treatment modalities are being investigated for the laser as well, including cataract incisions, capsulorhexis, scleral tunnels and flaps, and a glaucoma treatment.

Sergio Kwitko, MD, of Brazil, discussed the features and advantages of the WhiteStar ICE (Increased Control and Efficiency) technology in cataract surgery. One of the features of ICE technology is CASE (Chamber Stabilization Environment) technology that allows surgeons to optimize the unit's fluidics during cataract removal and reduce surge on occlusion break.

Felipe Vejarano, MD, of Colombia, outlined the features and components of the WhiteStar Signature phacoemulsification system that was recently introduced at the American Society of Cataract and Refractive Surgery annual meeting in San Diego. Dr. Vejarano highlighted some of the main features, including fusion fluidics technology and a power matrix ultrasound control.

The fusion fluidics has a dual pump that allows for the performance of a venturi pump and the control of a peristaltic flow-based pump, providing a stable environment for the surgeon and patient. The system provides the ultimate chamber stability and effectively reduces post-occlusion surge by a significant margin.

Ivan Ossma, MD, explained how multifocal IOL correction could be achieved for the patient with presbyopia. He outlined how multifocal lenses are an option that can provide spectacle independence for such patients.

Dr. Ossma highlighted the various features and advantages of two multifocal lenses (ReZoom and Tecnis). He also showed the 12-month binocular postoperative data, presented at 2006 American Academy of Ophthalmology meeting, comparing the ReZoom with the Tecnis lens and offered the positive features of both lenses when they are mixed and matched.