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EW SHOW DAILY 16 Sunday, May 8, 2016 ASCRS News Today F emtosecond laser cataract surgery is moving toward eliminating the use of ener- gy in the eye to remove the nucleus, according to Eric Donnenfeld, MD, Rockville Centre, New York. During an update on femtosecond laser cataract surgery, part of the Technicians & Nurses Program, Dr. Donnenfeld showed a video of a cataract procedure performed on "a pretty advanced cataract" with no energy used. "In 10 years, every cataract surgery will be like this; it will basically be an aspiration procedure, and ultra- sound will become negligible," Dr. Donnenfeld said. The change is part of cataract surgery's movement from an ultrasound-driven procedure to a fluidics-driven procedure. Dr. Donnenfeld noted that eyes tend to have better safety results when less energy is used. Among his femtosecond cataract patients, the procedure is frequently quick, leaves the eye white and quiet, with better endothelial cell counts, and provides good visual outcomes. "Reducing the energy plays a very significant role" in such outcomes, Dr. Donnenfeld said. "A little bit of energy is fine but the less energy, the better." Improving femtosecond tech- nology in recent years has allowed him to perform aspiration-only procedures on up to 3+ corneal den- sities, whereas he only could do it in 1+ densities a couple of years ago. Research has shown that the use of femtosecond lasers reduc- es phacoemulsification time and energy. For instance, 1 study by Burkhard Dick, MD, Bochum, Ger- many, showed that use of the laser to break up the cataract reduced ultrasound energy by 86%. The ease of nuclear disassembly and phacoemulsification enabled by laser-assisted cataract surgery can reduce the risk of capsular tears and foster faster visual recovery, accord- ing to the research. Femtosecond use in cataract sur- gery can provide advantages in com- plicated cases, Dr. Donnenfeld said. For instance, the technology could ease nucleus removal in patients with shallow chambers that compli- cate insertion of the phaco tip. Technique advantages of fem- tosecond lasers include the ability to provide precise arcuate incisions, more precise capsulorhexis, and better primary cataract incisions. Additionally, new intraocular lens designs require the precision of fem- tosecond lasers. Despite such advantages, Dr. Donnenfeld said it is not yet clear that femtosecond laser-assisted cata- ract surgery is better than traditional phacoemulsification procedures and noted some drawbacks, including subconjunctival hemorrhage, pupil constriction, and retained nuclear fragments. Retained nuclear fragments are a greater risk with laser-assist- ed procedures because the waffle pattern used leaves behind much smaller nuclear fragments, which can become lost behind the iris and reappear later. "You have these little chips when you break up the lens and sometimes they can hide under the iris; when that happens you have to look for them. If you don't, you will come back the next day and have nuclear chips sitting in the anterior chamber," Dr. Donnenfeld said. He urged surgeons to use less ag- gressive hydrodissection and ensure they look for the nuclear fragments. To Dr. Donnenfeld the real advantage of use of femtosecond laser cataract surgery is its ability to help the average or below-aver- age surgeon. In his own practice, Dr. Donnenfeld has found that the technology has allowed the average surgeons to obtain identical out- comes as the best surgeons. "It raises the bar for all oph- thalmic surgeons to become better surgeons, and—most importantly— it increases the chances that our pa- tients are going to have superlative outcomes," Dr. Donnenfeld said. Dr. Donnenfeld urged surgeons skeptical of femtosecond laser-assist- ed cataract surgery to keep an open mind toward it. "In the near future, you certain- ly will be doing this type of surgery as it becomes better and better," Dr. Donnenfeld said. EW Editors' note: Dr. Donnenfeld has financial interests with Abbott Medical Optics (Abbott Park, Illinois), Alcon (Fort Worth, Texas), and Bausch + Lomb (Bridgewater, New Jersey), among other companies. by Rich Daly EyeWorld Contributing Writer The future of femtosecond cataract surgery

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