ASCRS Live: Practical experience using the ALLY cataract femtosecond laser cataract system

Rob Weinstock, MD from the Eye Institute of West Florida presented on his experience working with the ALLY cataract femtosecond laser cataract system from LENSAR at the 2023 ASCRS annual meeting in San Diego.

Video transcript

Editor’s note: Transcript lightly edited for clarity.

Rob Weinstock, MD:

Hi, I'm Dr. Rob Weinstock from the Eye Institute of West Florida in Tampa Bay, Florida, and I'm here in San Diego at the 2023 ASCRS convention. I'd like to share with you some thoughts today about the ALLY cataract femtosecond laser cataract system that is just available from LENSAR. This system is the first second-generation femtosecond laser cataract platform on the market. I acquired the first commercial unit of the ALLY about 6 months ago when it first received clearance and it's really exciting to be using this new technology. It's a huge generational step up from the current level that we have with previous-generation technologies and I've used most of the femtosecond laser platforms.

This platform is a dual-pulsed laser and that means it has two separate laser profiles: one for corneal work like arcuate incisions, limbal-relaxing incisions, corneal marks... It also has a different laser profile and beam setting, different pulse selection, for deeper tissues like the capsulotomy and fragmentation.
The speed of this laser is pretty phenomenal. We can come into the laser suite and dock the patient and do the treatment in under a minute, which is almost probably at least twice, if not three or four times, as fast as the other platforms out there. So this is adding a huge level of efficiency and throughput to our surgical day with less downtime and availability of the laser just to perform seamlessly throughout our day. Most of the patients we do today are getting femtosecond laser treatments and astigmatism correction management at time of surgery.

This technology incorporates a lot of the really unique features of the previous-generation LENSAR which are unique in its class in that it does preoperative input from devices in the clinic, like we have...the IOLMaster and Cassini...Pentacam [they] can all import a digital image of the eye wirelessly into the operating room that when the patient has docked under the laser, a really quick iris registration process happens. So we truly can align say, the toric IOL marks or the arcuate incisions that we place on the cornea in the exact location of the astigmatism with no cyclotorsion errors. This adds a huge level of accuracy for astigmatism management for our patients.

It also has a unique feature that the capsulotomy has these little nubs on it, which was created in a previous generation and we still use on our torics so we know where to place the toric IOL. Postoperatively, we can see if the lens moves by dilating the patient any point postoperatively and see these little marks on the capsule to make sure that our lens is in the proper location.
Here at ASCRS, myself and my fellow are presenting several papers about this new technology. One paper is showing the reduction in surgical time and phacoemulsification energy that is used during cataract surgery comparing a similar cohort to basically a patient, one eye versus the other (one eye manual, one eye with fragmentation), with customized fragmentation patterns and automatic nuclear density grading showing that the group that receives the femtosecond laser treatment has less phaco time and less surgical time than a standard manual.

We're also showing the efficiency and the usability in a setting where there's two surgeons where a fellow or a second surgeon does the femtosecond laser treatment, and then helps the primary surgeon doing other cases or existing cases. We're using a two-surgeon flow model where we can accomplish somewhere between 8 to 9 cataract surgeries all getting femto in an hour, so there's really 17 or 18 procedures being done, including femto, in an hour which really helps us get through our day or business surgical day very quickly. It's a nice feature that femtosecond laser cataract surgery is playing into the efficiency, the ability to deliver really fast efficient care in an outpatient surgical setting.

So I'm super excited about the LENSAR Ally platform. [It's a] game changer. It's a great company that focuses primarily and only on laser cataract surgery, which is unique to the industry. The innovation is going to just keep coming and we're going to keep experiencing great results with this technology. I urge anybody to check it out and really consider it because it really adds a lot to a practice and especially for refractive cataract surgeons having a femtosecond laser. It's a really important tool for outcomes. Thanks.