Device clinical role at work

Orlando, FL-Accumulating data are demonstrating that use of the femtosecond laser improves the efficacy and safety of cataract surgery. Now, time will tell what role this new technology will have in clinical practice, said Michael C. Knorz, MD, in a keynote lecture during Refractive Surgery Subspecialty Day at the annual meeting of the International Society of Refractive Surgery/American Academy of Ophthalmology.

"There are a number of issues to be considered, including whether patients will understand and embrace the technology to support its place in the market," said Dr. Knorz, professor of ophthalmology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.

Currently, femtosecond lasers for use in cataract surgery are being marketed by several manufacturers, but their regional availability and approved indications vary. The LenSx laser (Alcon Laboratories) was the first to receive FDA approval for cataract surgery. It has integrated optical coherence tomography (OCT) guidance and has FDA approval and the CE mark for performing capsulorhexis, lens liquefaction, and corneal incisions.

The Catalys Precision Laser (OptiMedica) uses a liquid optic interface and online OCT. It is not approved in the United States, but has the CE mark for use in capsulorhexis and lens fragmentation.

The LensAR Laser System (LensAR) was initially designed to be used for lens softening in a procedure for correcting presbyopia. It is actually a picosecond laser and has a Scheim pflug camera for imaging, which is not real-time. The LensAR laser has FDA approval for lens fragmentation and capsulotomy.

The Victus (Technolas Perfect Vision/Bausch + Lomb) is a combined platform that can be used for lens surgery as well as for multiple corneal applications, including flap creation, intrastromal presbyopia correction (INTRACOR), corneal transplants, and astigmatic keratotomy. However, it is not approved in the United States or Europe for capsulorhexis or lens liquefaction.

Dr. Knorz said that his personal experience with femtosecond laser cataract surgery began in 2009 when he had the opportunity to operate with Zoltan Nagy, MD, at Semmelweiss University, Budapest. Dr. Nagy was involved in the development of the LenSx laser and was the first surgeon in the world to use the femtosecond laser in cataract surgery.

In July 2011, a LenSx laser was installed at Dr. Knorz's institution in Mannheim. Dr. Knorz noted that in contrast with the United States, where the femtosecond laser portion of the procedure is performed in a laser suite outside of the operating room, the femtosecond laser at his facility is set up in the operating room where the cataract procedure is performed.

Discussing the advantages of using the femtosecond laser in different steps of the cataract surgery procedure, Dr. Knorz noted that the laser has been shown to increase the predictability of both size and shape of the capsulorhexis. In one comparative study, 100% of capsulotomies created with a femtosecond laser were within 0.25 mm of intended diameter whereas this level of accuracy was achieved for only 10% of capsulotomies created with a manual technique.