“Do I Really Need a Laser for Cataract Surgery?”

THIS HIGHLY SKILLED SURGEON DECIDED THE ANSWER WAS YES. HERE’S WHY.

By Robert P. Lehmann, MD

When I first saw videos of laser-assisted cataract surgery performed by Stephen Slade, MD, and Robert J. Cionni, MD, in late 2010, I thought it was an interesting concept, but I wondered if I really needed this technology. I’m a competent surgeon. I did a residency in ophthalmology at Baylor College of Medicine, and I’ve been in practice since 1977. I consistently make a nice centered capsulorhexis that’s about 5 to 5.5 mm. I really felt like I had this. But then I thought about what the femtosecond laser has done for LASIK, how precise the laser is compared with a metal blade. As the femtosecond laser technology for cataract surgery evolved over the next few months, with several upgrades introduced during that time, I realized this is the wave of the future and I wanted to be on the cutting edge. After some due diligence, my administrator and I concluded that purchasing the LenSx Laser was not only economically feasible, but more importantly, would be in the best interests of my patients. So, almost 12 months after my first skeptical impressions, I purchased the LenSx Laser system.

Room set-up with moveable electronic (clutched) bed set for LenSx.

Bed moved over to microscope for Centurion/ORA and case completion.

Precision for Optimized Outcomes

When I make arcuate incisions, I prefer to create them with the LenSx Laser, because I can set the depth and adjust the chord length precisely, using real-time optical coherence tomography. When I use a diamond blade, these measurements can be variable and imprecise.

When using the LenSx Laser for cases in which I’ll be implanting advanced-technology IOLs, I’m confident my capsulotomies will be exactly the diameter I choose and centered exactly where I want them. As we know, proper lens positioning is critical for optimal patient outcomes. With the current software, my LenSx Laser centers the capsulotomy and creates the exact same size, case after case. This precision and consistency allows me to track my results and determine my personalized A constant. The bottom line for me is all about pleasing my patients, and by optimizing my refractive outcomes, I’m confident I will get patient-pleasing results.

I also appreciate that I use less ultrasonic energy for LenSx Laser cases, because the disassembly and softening of the nucleus has been accomplished in part by the laser.

As a surgeon who has done blade-free LASIK for years, I believe even a surgeon who has never performed LASIK will have a minimal learning curve, docking and treating with the LenSx Laser. It’s very user-friendly.

Ergonomic System

Initially, I’d planned to place the laser outside of my operating rooms, but after looking at the total overall space in my facility, I decided it would fit most ergonomically in one of the operating rooms. With upgrades to the platform, the LenSx Laser is a very ergonomic system. My nurse walks the patient into the operating room, where he or she lies down on the portable bed, which is already positioned near the laser. The total treatment time from when the patient lies on the bed through instillation of the anesthetic drop, placement of the lid speculum, docking, treating and undocking, is approximately two and a half minutes. The patient is then moved on the same bed about 4 feet to where the Centurion Vision System is located for completion of the procedure. This extra time is then compensated for by not having to manually create incisions or perform the capsulorhexis and further by some reduction in phacoemulsification time and energy as the nucleus is partially pre-treated by the laser. Of greater importance once again is the fact that I’ve seen patient-pleasing surgical outcomes, and fewer refractive touch-ups.

Up Your Game

I think many us who have been in practice a while feel we’re quite competent and don’t need a laser to perform cataract surgery. To those of you who still feel this way, I encourage you reconsider. The LenSx Laser facilitates consistently centered capsulorhexes and accurate lens placement, particularly for toric and multifocal lenses. It helps refine our results and maximizes the excellence we already were achieving. In my opinion, the precision of the laser will beat the human hand pretty much every time. It’s tough to beat an instrument of this quality for consistent results. ■

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