How to transition to femtosecond laser-assisted cataract surgery

Listen to Shameema Sikder, MD, provide strategies for how to prepare for the transition to femtosecond laser-assisted cataract surgery during the annual Current Concepts in Ophthalmology meeting at the Wilmer Eye Institute/Johns Hopkins University.

Take-home

To prepare for the transition to femtosecond laser-assisted cataract surgery, surgeons must be prepared for the learning curve and other practical considerations this implementation requires.

By Liz Meszaros; Reviewed by Shameema Sikder, MD

Baltimore-New technologies-such as femtosecond laser-assisted cataract surgery-can be exciting for ophthalmologic surgeons. But, to be smooth and successful in the transition, surgeons must be prepared for the learning curve and other practical considerations this implementation requires, said Shameema Sikder, MD.

“A pivotal question that we, as surgeons, need to ask ourselves is ‘How do we effectively make that transition from a novice to an expert?’” said Dr. Sikder, assistant professor of ophthalmology and cataract surgery education, and medical director at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore.

She reviewed some of the learning and teaching aspects of the use of femtosecond laser-assisted cataract surgery.

“We know that cataract surgery involves several mechanical steps . . . and there is definitely a learning curve,” she said. “But, with proper education, the advances in technique can definitely be made in a very efficient and proficient manner.”

Current strategies for teaching cataract surgery can be broken down into two categories: theoretical introduction to teaching surgery and the actual physical practice of surgery.

“With theoretical introductions, we are all familiar with written materials. While you can read an essay about a surgical technique, it’s not quite as valuable as being able to perform the technique with an expert by your side,” she said. “That is why the physical practice component has such a great importance in learning new techniques, including the opportunity to work in wet lab not only practicing on animals or on simulated models, but also the potential use of virtual reality computer simulators.”

Making the transition

Why transition into this new technology? What are the incentives?

“Not only do we want to understand what the limits of new technology are, but we also want to objectively compare outcomes,” Dr. Sikder said.

Ophthalmologists who have completed their training and are already in practice have very real considerations about not only the financial impact but at what cost these new technologies will be introduced into an already existent practice base.

Other considerations and challenges to adopting this new technology also include incomplete wound creation, astigmatism management with nomograms may become quite variable, and surgeons may need to develop their own custom nomograms. Surgeons must be able to understand the complications that may arise, including an incomplete capsulorhexis, limitations associated with small pupils, and how does femtosecond laser technology interface with advanced cataracts.

Dr. Sikder offered some particularly salient pearls for adapting new surgical techniques:

·      Keep expectations low. As surgeons are able to offer new technologies to their patients, offering them 20/10 vision with a toric lens may not be appropriate. Discuss new technologies with patients, but recognize and point out that this is a technology to do something that today’s surgeons already do quite well.

·      Ask for help. Residents have access to all manner of faculty members if they need help. But for those who are no longer residents, who are already practicing, it’s important to recognize that there is still help available, in the form of colleagues and meetings.

·      Minimize the variables. When using new technology on patients, do not jump in without perfecting both your techniques and your protocol.

·      Track data, specifically ‘your’ data. As surgeons move into more patient- outcome−oriented practices, they must make sure to track how patients are doing, how much refractive outcome or how much astigmatism is being induced with their wounds. This will affect individual nomograms for astigmatism management.

·      Review surgical videos.

·      Ask what could have been done better.

What does the future hold?

“As we move to more technology-laden practice, more automation, faster technology, if the question is, ‘Do we still have job security?’ the answer is ‘yes.’ No matter how much technology is helping us with the actual surgery, surgeons still need to be able to step it up, and bridge the gap,” Dr. Sikder concluded.

Shameema Sikder, MD

E: ssikder1@jhmi.edu

F: 410/614-9632

Dr. Sikder has no disclosures.