Eyeworld Daily News

EW SHOW DAILY 10 by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer ASCRS News Today Sunday, April 19, 2015 Dr. Khandelwal said that nurses would be involved in steps 5, 6, 8 to 14, with a floating nurse assisting with the laser removing the need to pull out a scrub nurse, while clinical technicians would be involved in steps 2 to 5, 8 to 11, 14, and 15. Dr. Khandelwal broke the workflow down into 3 basic activi- ties: pre-procedure, which includes dilating the patient's pupils and applying topical anesthesia; the laser procedure; and lens removal and IOL implantation. EW Editors' note: Drs. Khandelwal and Koch have no financial interests related to their talks. O ne of Saturday morning's Technicians and Nurses Program sessions focused on what course instructor Douglas D. Koch, MD, Houston, called "a very interesting and controversial aspect of ophthal- mology." Dr. Koch gave a concise sum- mary of the technology, offering his perspective on certain issues. The femtosecond laser, he said, offers a way to improve potential- ly problematic areas in cataract surgery—the incision, which needs to be water tight; the capsulorhexis, which some surgeons can do perfect- ly every time, others not so much; and IOL centration. In each of these cases, he said, the femtosecond laser offers precision that simply cannot be matched manually. This, in theory, leads to im- proved refractive outcomes, re- ducing variations in effective lens position and lowering the risk of IOL decentration or shift. The laser "replaces 3, maybe 4 of the least predictable steps ... we think it improves safety." "The funny thing is we still haven't proved this stuff yet," Dr. Koch said. There are other points of con- tention. In terms of the strength of the capsulorhexis, Dr. Koch said that there has been "a lot of discussion" with strong opinions either way. "My impression is the femto capsulorhexis is slightly weaker." He posited that the many mi- cropunctures created by the femto- second laser rather than the contin- uous tear of a manual rhexis might result in the slight weakening he has observed. This fundamental aspect of how the femto laser works also has Dr. Koch wondering whether there might not be some difference in terms of how they seal. Experience so far shows femto incisions "don't seal any differently" than manual incisions, but Dr. Koch pointed out that the laser might actually create little gaps or an absence of tissue since it works by creating "micro- explosions" in the tissue. Nonetheless, "the neat thing is you can have it cut any way you want," he said. The only "tricky" thing is positioning limbal incisions relative to limbal vessels, which are positioned differently from eye to eye. In Dr. Koch's experience, where the femtosecond laser presents a clear advantage—apart from the pre- dictability, precision, and accuracy of its incisions—is in lens fragmenta- tion. This is so effective that, in soft lenses, Dr. Koch doesn't use phaco anymore. One question that might help resolve the absolute value of femto- second lasers in cataract surgery is would it make the procedure safer for the below average surgeon? Dr. Koch said the femtosecond laser offers the opportunity to elimi- nate outliers in cataract surgery— the potential to introduce a level of consistency beyond what is possible with manual surgery. In the same session, Sumitra Khandelwal, MD, Houston, discussed the role of nurses and technicians and the integration of femtosecond lasers into a practice. "It's all about the procedural workflow," Dr. Khandelwal said. "It's a whole different procedure in some ways." She offered a sample procedural workflow that includes additional steps for laser cataract surgery: 1. System install 2. Patient exam 3. Treatment plan entry 4. System prep 5. Patient check-in 6. Patient prep 7. Patient transfer 8. Procedural timeout 9. Dock patient 10. Treatment confirmation 11. Conduct treatment 12. Patient transfer 13. Phaco/IOL implantation 14. Reporting 15. System clean up 16. Follow up 17. System service Course outlines role of technicians and nurses in femto cataract surgery It's all in the Cube International SurgiCube R Ultra Clean Air Where You Need It Think outside the box into the Cube! Visit us at ASCRS Booth #241 www.surgicube.com Pending 510k clearance Win a 2015 Tesla at the ASCRS•ASOA Symposium & Congress L ooking for a cool ride? Then make sure to get a ticket to win a 2015 Tesla. Attendees of the 2015 ASCRS•ASOA Symposium & Congress can enter to win a 2015 Tesla Model S. The Tesla will be located in front of Exhibit Hall D of the San Diego Convention Center during exhibit hall hours, which are 9:00 a.m.–5:00 p.m. on Saturday through Monday. A limited number of tickets will be distributed to attendees by participating exhibitors in the exhibit hall. Additionally, ASCRS•ASOA will distribute tickets to attendees who have made a $50 donation to the ASCRS Foundation during registration or at the ASCRS•ASOA Gateway. You can visit the Gateway in booth 1307. No attendee may submit more than 5 tickets. The grand prize winner will be announced at the ASCRS•ASOA Gateway on Monday at 2:45 p.m. You must be present to win. Prize and winners are subject to ASCRS•ASOA rules and terms. Enter now! EW

• Cover