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EW SHOW DAILY 28 ASCRS Symposia Tuesday, May 10, 2016 outperform phaco," he said. Howev- er, Dr. Barry cautioned attendees not to think that ESCRS is against femto. Using the femtosecond laser is still in its relative infancy, and phaco has been around for a long time, he said. Peter Hersh, MD, Teaneck, New Jersey, provided attendees with an update on corneal collagen crosslinking, which was recently approved in the U.S. The recent- ly approved crosslinking includes 2 forms for riboflavin, Photrexa Viscous and Photrexa, which are ap- proved for use with the KXL System (Avedro, Waltham, Massachusetts), an ultraviolet light-source platform. The specific approval in the U.S. is collagen crosslinking for the treat- ment of progressive keratoconus for patients 14 years old or older. The goals of crosslinking are to stabilize disease progression, avoid loss of BSCVA, and improve corneal topog- raphy, Dr. Hersh said. "I think it's very fortunate for us in the U.S. to be able to offer crosslinking, which is a major advancement in the treat- ment of keratoconus," he said. Meanwhile, also on the topic of crosslinking, Ronald Gaster, MD, Beverly Hills, California, discussed crosslinking in young patients. A di- agnosis of keratoconus before adult- hood generally has a poor prognosis, Dr. Gaster said. Progression of kera- toconus is generally faster in these patients. There is also increased probability that the patients will need a penetrating keratoplasty (PK) and greater and longer risk of rejec- tion of the PK over the lifetime of a younger patient. Dr. Gaster has been working to evaluate if crosslinking in adolescents is safe and effective in halting progression of keratoconus. He concluded that crosslinking in adolescents is safe, stops keratoco- nus progression, improves UCVA, improves BSCVA, decreases spherical equivalent, decreases maximum keratometry, and probably improves quality of life. It should be done sooner rather than later, he said. Editors' note: Dr. Barry and Dr. Gaster have no financial interests related to their comments. Dr. Hersh has finan- cial interests with Avedro. by Ellen Stodola EyeWorld Senior Staff Writer measured, he said, were circularity of the rhexis, centration of the rhexis, absolute phaco energy, the femto platform used, endothelial cell loss, effective lens positioning, and high- er order aberrations. So, does femto outperform pha- co? Femto patients have less postop- erative astigmatism and less surgery induced astigmatism, Dr. Barry said. However, femto patients have worse postoperative visual acuity. Addi- tionally, femto patients have more postoperative complications and more patients with postoperative vi- sual acuity worse than preoperative- ly. "So in this study femto does not does better. The patients who had postoperative cylinder greater than or equal to 1.5 D was 9% in the femto group compared to 18.5% in the phaco group. The femto group also performed better with surgically induced astigmatism. Dr. Barry stressed what was and wasn't measured in this study. They did measure surgical difficulty, ocu- lar comorbidity, preoperative com- plications, monofocal vs. premium IOLs, postoperative complications, visual acuity, biometry prediction error, postoperative cylinder, and surgically induced astigmatism. Meanwhile, factors that were not T hree different ophthal- mology "controversies" were discussed during the "Controversies in Anterior Segment Surgery" sympo- sium on Monday afternoon. Ex- perts highlighted complications in femtosecond laser-assisted cataract surgery (FLACS) compared to manu- al phacoemulsification, topograph- ic-guided ablation in LASIK, and corneal crosslinking: when do you treat keratoconus. Peter Barry, MD, Dublin, presented on results of the ESCRS FLACS study. This was a case control study where surgeons were self-se- lected, with a learning curve of 50 or more cases. The patients in the study, meanwhile, were surgeon selected, and consecutive cases were submitted. The femto patients were entered prospectively into the EUREQUO database, Dr. Barry said. Recruitment for the study oc- curred from December 2013 to the end of May 2015 and included 3,379 femtosecond cases from 16 centers in 10 countries. Out of nearly 300,000 eyes from the 2014 EUREQUO database, about 30,000 were selected to compare with femto. Of the 3,379 femtosec- ond cases, 565 were not matched. The total number of matched femto cases was 2,814, and 4,987 matched phaco. In terms of preoperative surgical difficulty, Dr. Barry noted that 4% of the femto group had undergone previous cornea refractive surgery, compared to only 0.1% in the phaco group. Preoperative ocular comor- bidity rates were "strikingly similar" he said. Overall the femto group did a little worse in preoperative surgical complications when you exclude femto specific complications, Dr. Barry said. Meanwhile, postoperative BCDVA was slightly worse in the femto group. The visual acuity in both groups was the same prior to surgery, but 3.3% of the femto group was worse after surgery, compared to 1.3% in the phaco group. In terms of astigmatism, Dr. Barry said that femto definitely Anterior segment controversies Dr. Barry presents on the ESCRS FLACS study.

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