Reduce Surgical Variability

THE LENSX LASER PUTS PRECISION IN YOUR HANDS FOR WELL-CENTERED CAPSULOTOMIES AND ON-TARGET SURGICAL RESULTS.

By Michael P. Jones, MD

My partners and I were some of the earliest adopters of femtosecond laser technology for cataract surgery. As soon as the U.S. Food and Drug Administration cleared the LenSx Laser for use, we purchased one. The main reason we jumped in right away was because we implant a large number of advanced-technology IOLs. When using these premium lens implants, hitting refractive targets is critical; otherwise, touch-up procedures are inevitable. Regardless of how experienced and skillful a cataract surgeon may be, it’s virtually impossible to create a perfectly centered, consistently sized capsulorhexis by hand every time. We felt the precision, accuracy and predictability of the laser would improve our advanced technology lens results and, in turn, reduce the need for postoperative adjustments.

Indeed, once we started using the LenSx Laser, something happened that was surprising and unexpected. Patients who were scheduled for standard lens implants were still opting for the LenSx Laser. In fact, today, approximately 70% of our laser-assisted cataract surgeries are performed on patients who receive a standard aspheric single-piece, monofocal lens with LenSx arcuate incisions. Although they may not choose advanced-technology IOLs, patients appreciate that the laser will contribute to a fast, comfortable procedure with predictable results, and, at least for distance vision, they have a much greater chance of not needing eyeglasses after surgery.

We decided to purchase a femtosecond laser for cataract surgery at a time when only the LenSx Laser was available. Since then, we have added a second LenSx Laser, and this year, we will add a third. I would like to highlight the main reasons we continue to choose the LenSx Laser.

LenSx Laser Advantages

Alcon LenSx is always looking to improve the LenSx Laser, and many improvements are driven by user comments. Alcon has been extremely responsive to our suggestions and requests, quickly incorporating updated and improved features into newer versions.

The SoftFit Patient Interface is an example of that responsiveness. Based on feedback from surgeons, the company modified the original patient interface to offer the benefits of both a rigid interface and a fluid interface. The result is what I believe is the best of both worlds. The SoftFit Patient Interface stabilizes the globe, so there’s no movement or artifact, and the cornea conforms to the soft contact lens insert for a gentle, secure fit with reduced distortion. This enabled us to create complete capsulotomies with pristine edges. Since we began using the SoftFit Patient Interface, the incidence of incomplete capsulotomies at our ASC is almost zero.

Another advantage we’ve seen with the LenSx Laser is the speed with which we can complete a procedure. I can dock the eye, align my incisions, treat the eye and have the patient in the operating room typically in less than 2 minutes. Part of this efficiency comes from the fact that the LenSx Laser doesn’t have a fixed bed, enabling us to maintain our flow and our volume with very little disruption. When a laser has a fixed bed, the patient must move from the stretcher onto the laser bed to be treated, then back onto the stretcher to be moved to the operating room. All of that unnecessary movement slows us down. The LenSx Laser works with our standard OR bed. That was another key feature for us.

Finally, the LenSx Laser integrates into Alcon’s Cataract Refractive Suite, which includes the Verion Image-Guided System. The two key components of the Verion Image System are its Reference Unit and Digital Marker. The Verion Reference Unit takes a high-resolution digital image of the patient’s eye preoperatively, capturing scleral vessels, limbus and iris features. Using this reference image, you can precisely position all incisions and alignment in real time. The system automatically imports biometry measurements, patient data and the reference image into the planning software, so you can quickly set up your preferred surgical parameters while minimizing the likelihood of transcription errors. The Verion Digital Marker eliminates the need to pre-mark the eye with ink. When you dock the eye on the laser, the Verion Image System automatically tracks and accounts for any eye movement or cyclorotation, enabling you to center your capsulotomy on the patient’s preoperative undilated pupil. The system intuitively knows the exact position of the eye at all times, which helps you precisely center your IOL. That is pretty amazing. We never had that ability before the Verion Image System was introduced.

Frequently Asked Questions

Whenever surgeons discuss laser-assisted cataract surgery, three questions typically arise:

1. Is it financially feasible for a practice to have a femtosecond laser for cataract surgery?

Buying a laser is a significant investment, but I wouldn’t be adding a third laser to my practice if it weren’t financially feasible for us. More than just feasible, it is necessary. Patients nowadays tend to research their medical problems online, and anyone researching an upcoming cataract surgery will learn that laser is an option. In my opinion, it’s going to be more of a financial hit to not have a laser than to have one.

2. Does an experienced, competent cataract surgeon really need this laser?

Ophthalmologists who have been performing cataract surgery for 15 or more years are good surgeons. They know how to remove a cataract. They often ask, “Do I really need a laser to take out a cataract?” If you’re doing manual cataract surgery, not offering options, and not really concerned about improving your refractive outcomes, then I think it’s perfectly fine to keep performing cataract surgeries by hand. I think what you’ll find, however, is that patients are becoming more demanding. I think it’s our duty as physicians to explore options with patients, even if it’s not something that you do. If I needed knee surgery and found out there was some new way of doing it that my doctor didn’t tell me about, I’d be upset. Laser-assisted cataract surgery is a real option in 2015, and surgeons should be discussing it with their patients.

3. Won’t the laser add time to each procedure?

Initially it will. When you do anything new, there’s a bit of a learning curve, and you’ll need to adapt to a new flow pattern to incorporate the laser. The more procedures you perform with the laser, the more efficient you’ll become, because the laser takes care of the majority of the surgery before you enter the operating room. Your corneal cuts and capsulotomy are done, and your nucleus is already divided for you. So as you get more experience, you’ll find that your surgeries actually take less time. After having completed more than 3,000 laser-assisted cataract surgeries, I’m much faster performing a laser cataract surgery than performing the entire procedure by hand.

I have one recommendation about where you place the laser. We placed it in the pre-op holding area, and that has been efficient for us. If it’s feasible and you have space, I would strongly recommend that you place your laser outside of your operating room, so you can maintain a flow pattern that’s similar to what you had without the laser.

Low-cost, High-impact Marketing

Our practice is large enough that we can participate in multimedia marketing. However, we’ve found one economical yet effective marketing tool that will work for any size practice without the expense of TV or radio advertising.

We work very hard on patient education, and that starts before a patient comes to our office. When someone calls specifically requesting a cataract evaluation, or if he’s in the at-risk age group and reports blurry vision and nighttime glare, we send him a brochure in advance of his appointment. Written in simple non-technical language, the brochure explains what cataracts are and the different surgical options we use to treat them. The brochure is very powerful. By the time patients see me, most of them are quoting right from it, asking questions about their options.

Although you can obtain ready-made mailers from various sources, I recommend that you design one specifically for your practice. Every practice is different, and you know what will resonate with your patients. Include it in a pre-visit packet that’s mailed to patients. Most patients will start thinking about their options before they walk through your door.

Reduce Variability, Enhance Surgical Results

The LenSx Laser reduces the variability of manual cataract surgery. It provides an efficient way to remove cataracts for the modern patient. By reducing variability, I feel it delivers more accurate results than manual techniques. As more and more patients seek refractive surgery-type outcomes from cataract surgery, the LenSx Laser is an invaluable tool. ■

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