Laser update aids cataract outcomes

Reviewed by Jonathan Solomon, MD

A third system upgrade for a femtosecond laser system for refractive cataract surgery (Streamline III, LENSAR) will enhance the efficiency of the procedure, according to Jonathan Solomon, MD.

“I have seen a 15% reduction in the effective phacoemulsification time (EPT) with dense cataract since we implemented the new software,” said Dr. Solomon, medical director, Dimensions Surgery Center, Bowie, MD, and surgical/refractive director of Solomon Eye Physicians and Surgeons, which has Maryland and Virginia offices.

“If we’re delivering any type of energy, it’s a process inside the eye that has to be streamlined,” he said. “It takes time for the surgeon, it’s time inside the eye for the patient, and it could potentially have an impact on the surgical outcome.

“The fact that you’re able to deliver your needed laser treatment in a more efficient matter also makes the experience for the patient a whole lot easier and more comfortable,” he added, noting the time from the patient’s first encounter with the upgraded laser system to completion is less than a minute and a half.

“Energy reduction is one way the system has been improved, and superior imaging is another,” he said. “We’re able to achieve better 3-D reconstruction for the relevant anterior segment precision and delivery.”

With better imaging, surgeons can more easily create arcuate corneal incisions and more accurately deliver laser energy for the capsulotomy. It also allows energy delivery to be refined during fragmentation.

Surgeons now also have the option of a corneal incision-only mode in which they can perform laser corneal incisions independent of capsulotomy and fragmentation. This feature is beneficial when surgeons want to start and stop treatment with the cornea; for example, if the eye has a very small pupil and it might be unsafe to treat the lens.

Wireless iris registration can be done at the same time, and along with the wireless astigmatism data transfer feature, is designed to produce more precise treatment planning and more predictable results.

“When you eliminate certain variables where there is a potential for human error and allow the computers to talk to each other from a site such as your office to the operating suite, and also eliminate the time that it takes for data transfer, that’s another potential efficiency that comes with this upgrade,” Dr. Solomon said.

Patient experience

Patient experience

Dr. Solomon also emphasized patient experience should not be overlooked when considering the impact of technology. At his clinic, patients are routinely asked to grade their surgical experience under the laser on a scale of 0 (no pain) to 10 (extremely uncomfortable).

“It’s usually anywhere from 0 to 2, but we are getting a lot more 0 grades than we have in the last four years since we’ve had the laser, and in large part it’s because of the efficiency of the laser and the 20 to 30 seconds of time that they’ve been able to cut from the encounter itself,” he said.

Another feature is the ability to program certain components of the surgical process, such as diagnostic data.

Surgeons can input customized lens fragmentation patterns rather than rely on standardized cataract lens density grading. With customization, the laser can deliver energy to the parts of the cataract where it is most needed.

Vector planning for astigmatism can also be performed preoperatively and imported at the time of surgery.

Jonathan Solomon, MD

E: jdsolomon@hotmail.com

Dr. Solomon is a consultant for LENSAR and i-Optics.