EW SHOW DAILY
10
Wednesday, May 10, 2017
recovery, stability of outcome, fewer
higher order aberrations, and the
ability to hit the refractive target.
But a refractive outcome is only
as good as the weakest link, he said,
sharing the areas that he thinks are
the "weak links." The first was IOL
power because the true power of
the IOL is not known. IOL powers
for most lenses are only available in
half diopter steps, Dr. Cionni said,
and he thinks it's time to look at
labeling the true power of the lens
or going to quarter diopter steps.
He also mentioned the fact that
effective lens position (ELP) remains
an estimate even with LACS and
intraoperative aberrometry. Current-
ly, Dr. Cionni said that contralateral
eye studies are best for comparing
LACS to manual, and this approach
minimizes inter-patient variability
in factors that affect axial IOL posi-
tion. He said it's also important to
remember astigmatism.
So, can studies demonstrate bet-
ter refractive outcomes with LACS?
Dr. Cionni thinks the answer is yes,
although he noted that known ELP
or contralateral eye studies are need-
ed, best preoperative measurement
techniques need to be used, and the
best calculations or intraoperative
aberrometry needs to be used.
LACS has a number of benefits
in routine cases, Dr. Cionni said,
including more precise capsulotomy,
lower CDE, postoperative central
corneal thickness, reduction in
corneal endothelial cell loss, similar
overall complication rate, and lower
vitreous loss rate.
Dr. Cionni reminded everyone
how many years it took for the
benefit of phacoemulsification to
be realized. The superiority of small
incision phaco was not demonstrat-
ed until 2002.
He stressed the importance of
not repeating the mistakes of the
past. Don't knock a new technology
down because it is different, he said.
Evidence shows that LACS can make
a difference in routine cases and
certainly in challenging cases. Dr.
Cionni encouraged an open mind
as LACS continues to improve and
surgeons gain more experience with
it. LACS is the key to opening the
door to new innovative technologies
and techniques and providing better
outcomes for patients, he thinks.
Despite difficulty in demonstrat-
ing refractive superiority, LACS is
growing. Dr. Cionni again stressed
that contralateral comparison stud-
ies are best suited and have shown
refractive benefits of LACS because
they minimize the effect of uncer-
tain ELP. EW
Editors' note: Drs. Masket and Cionni
have financial interests with Alcon
(Fort Worth, Texas).
Dr. Masket discusses the benefits of laser-assisted cataract surgery (LACS).
Laser continued from page 6
