COMMENTARY

Femtosecond Laser: Why We Need It for Cataract Surgery

American Academy of Ophthalmology 2013

Roger F. Steinert, MD; H. Burkhard Dick, MD, PhD

Disclosures

November 22, 2013

In This Article

Do We Really Need Femto?

Dr. Steinert: We have arguments about whether there is a reason for femto. Is this all just industry pushing a laser? When phacoemulsification came of age, we had small-incision lenses, but we never would have had small-incision lenses without phaco. People say that the same thing is going to eventually play out here and that the femto will enable us to go to places we can't go right now technologically. What are your thoughts on that? Where do you think this is going to take us?

Dr. Dick: There are many things to explore. One thing might be a femto intraocular lens (IOL) that is fixated in where you have the rim of the optic, and the anterior of the lens is put into the back as you are used to, and you are fixating the capsule in the optic. The capsulotomy is done and is centered, and then you have the chance to fixate it. The potential advantages are that there is a good predictable effective lens position with low changes, anteriorly and posteriorly, because you are not that dependent on capsular back shrinkage, and the back shrinkage would just fixate the lens and prevent rotation in toric lenses, center the multifocal according to the line of sight or close to where you want it to sit, and many other interesting options.

Dr. Steinert: So you are a believer in line-of-sight centration.

Dr. Dick: I'm using the scanned capsule rather than the pupil. If the pupil centration is wide, it doesn't matter; but if it's a little bit smaller, I wouldn't go for pupil centration just for the so-called scanned capsule. That means that you take into account the anterior surface curvature, posterior curvature, as well as a 3-dimensionally analyzed line. You can nicely predict the position of the lens preoperatively or intraoperatively at that point. That is better than the pupil centration, because sometimes the pupil does not dilate well, sometimes it's asymmetric, and other issues can occur. So there are a lot of things to improve currently, but we are already on a very high level from where we started with this new technology.

Dr. Steinert: Have you heard from anyone -- or had your own thoughts about -- whether the femto will finally get us to the point where we have a true accommodating IOL? How would that happen?

Dr. Dick: That is a very optimistic idea. But there are many things to explore. Currently, we are still far away from a true accommodating IOL.

Dr. Steinert: We can always hope that we are going to get there. Thank you for joining us. I'm Dr. Roger Steinert with Dr. Burkhard Dick for Medscape Ophthalmology, from AAO 2013.

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