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EW SHOW DAILY 4 Monday, April 20, 2015 ASCRS News Today Massachusetts Eye and Ear Infirmary in Boston. Dr. Park then went through the various pieces of equipment with which cataract surgeons need to be- come familiar, including the opera- tive microscope, the phaco machine, the handpiece, the phaco tips and sleeves, and keratome blades. All phaco machines are "pretty similar," Uday Devgan, MD, Los Angeles, said. All these machines, he said, are made to work in a very tight space, with very little room for error. Talking about fluidic control, Dr. Devgan said that, basically, "fluid removed needs to be replaced." Reiterating Dr. Park's point, it is useful to know about the machine you are using. In the case of fluidics, the surgeon should know whether the machine being used uses a peri- staltic or venturi pump. "If it has a plastic bag it has a peristaltic pump," Dr. Devgan said, suggesting a short cut. Peristaltic pumps require total occlusion to produce effective vacuum. "Venturi creates vacuum directly in a rigid drainage cassette, creat- ing vacuum instantly," he said. On the other hand, unlike peristaltic pumps, "it can't change flow direct- ly." Another fundamental aspect of cataract surgery the surgeon needs to be familiar with is the concept of phaco power. First, the surgeon should re- member that using phaco power is "unleashing cataclysmic forces into the eye," Dr. Foster said. "These forc- es are used to destroy"—that is, after all, their very purpose: to fragment and emulsify the cataract. Dr. Foster's second power fun- damental is that stroke is equal to stroke/arc length. This leads to the third funda- mental: Surgeons should match the stroke length to nuclear resistance. They should thus balance efficiency and safety. The fourth fundamental in terms of power is to only deliver power when nuclear material is at the tip. Finally, Dr. Foster said that sur- geons should modulate energies to protect against thermal injury. EW Editors' note: The physicians have no related financial interests. by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer "Introduction to Phaco" useful to those who are new to phaco, as well as those who are brushing up on the techniques. Basically, she said, learning pha- co is done in 3 steps: watch, read, and learn; know your equipment; practice. Dr. Park listed a number of resources available, including text- books such as Achieving Excellence in Cataract Surgery by D. Michael Cohrard, MD, FACS, Essentials of Cataract Surgery by fellow course faculty member Bonnie An Henderson, MD, Boston, and Phaco Chop by David F. Chang, MD. The Internet provides several other options. Dr. Park said that many of her residents go to YouTube, but recommended caution when using this resource because it provides unfiltered search results. Similar to YouTube but fo- cused on ophthalmology is EyeTube. The ASCRS also has its own online resource—the Phaco Fundamentals Classroom can be found on the so- ciety's website, and is available even to non-members. This resource, Dr. Park said, is vetted by an editorial board and features many of the excellent cataract courses taught by experi- enced surgeons throughout North America, such as courses taught at experienced surgeon, but are best learned by the neophyte during the early stages of training. "By understanding these funda- mentals, you'll be able to adapt your own settings," Dr. Foster said. "Most of us have learned the nuances of adjusting [phaco] machines from the [industry representatives]. More and more they're thinking they don't allow that." With practice, skilled users would be able to modify established technique to face cataract challeng- es. Beginning the session, Lisa Park, MD, New York, provided an I n a course on "Phaco Funda- mentals," experts provided ASCRS Young Eye Surgeons with just enough fundamentals to allow them to piece together their own cataract surgery. "The goal is just to review the fundamentals, not necessarily the how-to, but the fundamentals to allow you to piece together cataract surgery," said course instructor Gary Foster, MD, Fort Collins, Colo. These fundamentals include capsulorhexis dynamics, fluidics, power modulation, and I/A parame- ters. Knowledge of these fundamen- tals is essential even for the most Phaco fundamentals for Young Eye Surgeons Dr. Foster lists 5 fundamentals for power delivery in phaco surgery.

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