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M O N T H 2 0 1 4 | S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
A phaco-free future?
Femtosecond lasers use short pulses of energy to make precise cuts in the
cornea that are unmatched by even the most skilled blade-wielding surgeons.
The most important part of cataract surgery involves making the capsulorhexis,
which the laser does perfectly almost every time.
Each laser system has its strong points. All are excellent, although surgeons
might prefer the imag-
ing capabilities of one
to another. That's a cru-
cial difference for sur-
geons, too. They need
to gauge the thickness
of cataracts, know how
far below the cornea
the laser will perform
the capsulorhexis, and
soften and pre-chop the
lens nucleus. This
requires working with a
laser system that has
excellent imaging capa-
bilities.
Before laser proce-
dures, patients are
prepped as they are for
conventional surgery.
Instead of heading
directly into the OR,
however, they stop in a
dedicated room for the
O P H T H A L M O L O G Y
U
sing a femtosecond laser to perform cataract
surgery is clinically justified if a patient has a sig-
nificant amount of astigmatism to correct. What's
a significant amount? Half a diopter? Three-quarters of a
diopter? One diopter? That's often debated among ophthal-
mologists.
In my experience, patients with astigmatisms of .75 to
1.00 diopters are ideally suited for laser surgery, although
astigmatisms up to 2.00 diopters can be adequately cor-
rected with the systems. Beyond that, you have to use a
toric lens to achieve positive post-op vision results.
By using the laser to correct astigmatisms, surgeons
will also benefit from its ability to form perfect capsu-
lorhexis and soften the cataract before removal.
— James Salz, MD
PROFESSIONAL OPINION
When Do Lasers Work Best?
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