Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India

7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India

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Current Status of Femto-secondLaser Cataract Surgery

Dr. Vidushi Sharma, MBBS (AIIMS),MD (Ophthalmology,

AIIMS, New Delhi),FRCS (UK)

Dr. Suresh K Pandey,MS (Ophthalmology, PGIMER, CHANDIGARH),

Anterior Segment Fellowship (USA)

SuVi Eye Hospital & Research CentreC-13, TALWANDI, KOTA, RAJASTHAN, INDIA

Phone + 91 9351412449Email- [email protected]

www.suvieye.com, www.phacolasiktraining.com
mailto:[email protected]://www.suvieye.com/http://www.suvieye.com/mailto:[email protected]


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Instruction Course during APAO AIOS 2013meeting


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The authors haveno financial interest

in the subjectmatter of thispresentation


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Femto-laser Cataract Surgery

Trying to improve on the existingexcellent results

Paradigm shift

Comes with a huge price tag

Recurring costs of disposableequipments, maintenance costs (andclick fees)

Dr. Vidushi, MD, FRCS, SuVi Eye Institute, Kota, India


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Current Femto-cataract platforms

Dr. Vidushi, MD, FRCS, APAO-AIOS 2013


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Global Market share



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Perfectly centred &sized capsulotomy (IOLtilt & decentration)

Liquify, soften orchop the lens(reducing phaco energy

needed)

Precise corneal relaxingincisions

Incisions with perfectdimensions andarchitecture



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Femto Laser cataract



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Optimedica Docking



10/41Dr. Vidushi, MD, FRCS, APAO-AIOS 2013


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Repeatably precise capsulorhexis

Specialy useful in difficult cases like smallpupils, poor red glow and weak zonules



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Nucleus management



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Cataract incisions

Create multi-planarincisions withbetter sealability

0/42 eyes wth 2-plane laser incisionneeded stromalhydration to seal(LenSx Steinert R)


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Cost

cost between $400,000 and$500,000.

usage fee between $150 and $400per eye

maintenance contracts between

$25,000 and $50,000 per year



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Differences from FS lasers for Lasik



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Docking Systems



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Imaging Systems



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Imaging Systems



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Comparison of Platforms



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LenSx (Dr. C. Wavikar will share his experience)

First laser to getapproved for lasercataract surgery

Maximuminstallations allover the world

and Maximumeyes performed



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Victus (Dr K P Reddy will share his Experience)

Single platformfor refractiveand cataract

indications,though notapproved for all

uses Real time OCT

imaging



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LensAR

3-D confocal structured illumination(CSI) for imaging (based onScheimpflug principle)

Auto-measures and locates allsurfaces for treatment planning

noncorneal contact liquid patientinterface device filled with BSS



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OptiMedica

Liquid OpticsInterface

Integrated OpticalCoherence

Tomography(OCT) system



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But....

Real clinical benefits vs technological

Price tag and recurring costs

Worth the additional expense



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Transformative tool.......

Or extravagant toy for few?



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Problems

Increased chair time,heightened patient expectations

Lack of data showing significantimprovement in functional visualoutcomes such as better uncorrectedvisual acuity

Improvement of 1-2 % significant

Slows down surgeries



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Femtolaser cataract procedure



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What can be expected

If 92 percent within 0.5D ofemmetropia & 96 percent have 20/20vision or better, how much better can

you make it with a perfectly circularcapsulorhexis? (Its a bit like weighing theingredients of your cake down to the last microgram intellectually interesting but nobody can taste the difference)

Limitations of biometry and IOLcalculations

IOLs come in 0.5D steps



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Premium IOLs

femtosecond is hoped to improveresults with multifocal andaccommodative IOLs



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Multifocal & Accommodating IOLs

How many ophthalmologists wouldactually get a multifocal/accommodative IOL implanted in theirown eye as of today



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What we need to know

Perhaps one day this will becomestandard of care, but is today that day?



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New Set of problems

Its own learning curve

About 3 minutes of suction to performall of its steps, petechial hemorrhages

can weld the capsule to underlyingcortex, making hydrodissection moredifficult.

laser cuts of cortical material makeaspiration of cortex more difficult,potentially increasing PCO rates



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Parallels

Compared to introduction ofphacoemulsification

Also compared to introduction of IOLs But both of these underwent many

modifications to become universally

acceptable Essentially automation of a few steps



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Parallels

Intralase Femtosecond Laserintroduced in 2001 market share of

fs lasers purchased for LASIK flapcreation55 percent in 2010 realdemonstrable better visual results?Do patients pay the extra amount

Dodick laser

Fugo Blade



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Lessons from US

Cost matters decreased Medicare

payments, healthcare crisis

India - Move to have surgical rates

displayed moving to greater control



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Kind of marketing

The Hindu Feb 25 2012 While persons who undergo conventional cataract

operation needed to rest their eyes for a minimumof ten days, those who undergo the Femtosecond

laser procedure can start work immediately

Femtosecond 1,000 times more precise with littlescope for human error

Earlier laser vision correction surgery was possible

only if the thickness of the cornea was more then450 microns thick, but now the laser surgery couldbe performed on persons with corneal thickness ofless then 450 microns with new equipment



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My Conclusions

Wait and watch

Latest gizmo in town, Me too

Depends on type of practice groups

No need to feel pressured as of now

The surgeons who can afford it dontreally need it but will help inrefinements for the future!



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Thank You


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Current Status of Femto-secondLaser Cataract Surgery

Dr. Vidushi Sharma, MBBS (AIIMS),

MD (Ophthalmology,AIIMS, New Delhi),FRCS (UK)

Dr. Suresh K Pandey,MS (Ophthalmology, PGIMER, CHANDIGARH),

Anterior Segment Fellowship (USA)

SuVi Eye Hospital & Research CentreC-13, TALWANDI, KOTA, RAJASTHAN, INDIA

il i @ il
mailto:[email protected]:[email protected]

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Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India