Applying a LASIK Mindset to Cataract Surgery

THE LENSX LASER IS BUILT FOR PRECISION.

By Paul C. Kang, MD

My experience as a refractive surgeon strongly influences my perception of my cataract surgery outcomes. The way a LASIK surgeon looks at the world is that wearing eyeglasses and contact lenses is a problem, which means I’m always striving for the best possible visual outcomes. Applying that refractive surgery mindset to cataract surgery, I’m always looking for ways to refine my techniques, so that my cataract surgery outcomes will be on par with my LASIK outcomes.

Having used a femtosecond laser for LASIK for almost 10 years, I already appreciated its precision and accuracy, so I was intrigued when I learned a femtosecond laser was available for cataract surgery. Although LASIK and cataract surgery are different applications, the principles of the technology are the same. The question was: Can that type of precision improve my cataract surgery outcomes? Four years after my partners and I purchased a LenSx Laser, our results — and those of the surgeons who perform laser-assisted cataract surgery at our ASC — speak for themselves. The LenSx Laser has delivered on its promise of accuracy and precision, enabling me to meet not just my refractive targets but those of my patients, as well.

Precision Tailored for Each Eye

The consistency of the LenSx Laser enables me to maximize my nomogram adjustments and customize the position and size of the capsulorhexis for each eye. This ensures that each lens is positioned correctly, which is critical for hitting refractive targets, particularly when I’m using advanced-technology IOLs.

Another feature of the LenSx Laser that helps me customize my surgeries, and ultimately improve my surgical outcomes, is the integrated optical coherence tomography. This technology allows me to view an image of the lens and measure its thickness. That’s extremely helpful for planning surgery, as I can use the laser power to fragment the lens before I enter the eye.

The Softfit Patient Interface ensures a secure and gentle fit to the patient’s eye while reducing corneal distortion. This allows for accurate transmission of laser energy to the targeted tissue. With the integration of the Softfit Patient Interface, I have a high rate of complete capsulotomies.

This is a photo of the completion of a successful LenSx Laser case. You can see a picture of the complete capsulorhexis, divided lens, and arcuate incisions. The procedure is now complete.

Reliability Is Mandatory

In any busy ASC, efficiency is paramount, and the reliability of surgical equipment is critical. Fifteen surgeons work out of the one operating room in our surgery center. On any given day, 40 cases come through that one OR. Every doctor uses the LenSx Laser at some point during his or her surgery day.

With that kind of volume and the variety of different users, even a minor disruption can wreak havoc with our schedule. As you can imagine, when we’re operating at capacity, we can’t just cancel cases and move them. There’s no way to reschedule for tomorrow, because tomorrow’s schedule is already full. The LenSx Laser is extremely reliable. Over the past 4 years, I can think of only one instance when it was out of service. When that happened, Alcon was very responsive. Technicians were available immediately by phone to help diagnose the issue, and a service representative was on site later that day. We were up and running again, ready for the next day.

Open Dialogue With Alcon

Growing pains are inevitable with any new technology. There’s a learning process for everyone. Engineers who design medical equipment may have a perception of how it will function in the real world, but when it’s actually put into practice, unforeseen challenges may need to be addressed. Alcon’s collaboration with its LenSx Laser users has been remarkable and has resulted in upgrades to the platform. The SoftFit Patient Interface is one example of how users’ experiences initiated a design change. Alcon has also introduced lens-fragmentation patterns and automated centration, which are helpful features. Just as we’re accustomed to receiving upgrades for our smart phones and computers, the company is further refining the LenSx Laser technology.

High Patient Acceptance

There’s no question that purchasing a femtosecond laser for cataract surgery is a major expense. Surgeons often ask, “Do I really need it? How helpful is it for someone who already does great cataract surgeries?”

Your results will speak for themselves, but I can also tell you that patient acceptance of laser-assisted cataract surgery in our practice has been extremely high. That’s what’s so compelling about this technology. Patients love it. They equate using a laser during surgery with greater precision and accuracy.

Interestingly, the surgeons who operate at our surgery center represent different practices with different patient demographics and economic status in the Washington, D.C., metro area, yet laser-assisted cataract surgery with the LenSx Laser is being adopted across the board. To me, that says this isn’t just a niche type of procedure. This is something that has a place in mainstream ophthalmology and is being received extremely well by patients.

Building on Success

Cataract surgery is one of the most successful procedures in its own right, and it is still evolving. Many new tools, such as new IOLs, different methods for measuring lens powers, advanced topographers, and so on, are available to help us maximize results. The LenSx Laser is one of the tools that will be an integral part of that process. ■

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