In the cover story of this issue of OSN, we discuss new alternate devices that can assist in capsulotomy creation. Femtosecond laser surgery in the U.S. grew to 9.5% of all cataract procedures performed, up from 8.3% in the last quarter of 2014, according to Market Scope, an independent market research firm. Still, these instruments may not be affordable to some lower-volume surgery centers. While these less expensive alternatives may be better suited for some, they lack many of the most appealing features of laser-assisted cataract surgery for cases like these:
1. Routine challenges. For very dense cataracts and cases with pseudoexfoliation, many surgeons really rely on their femtosecond laser to soften the nucleus and allow less traumatic, less complicated disassembly because the vast majority of these patients have some degree of astigmatism and they get the added bonus of femto’s incisions. With time and advancing laser platforms, these benefits will only increase.
2. Oddball cases. Increasingly, we are learning how femtosecond surgery can allow safer phaco in cases with corneal scars, intumescent white cataracts and other challenges. Competitive capsulotomy makers may also offer some advantages in these cases, but none are quite as automated as the femtosecond laser.
3. Integration and surgical guidance.Increasingly, systems that measure preoperative corneal curvature and intraoperative aberrometry are directly integrated with each other, so the measurements from one machine auto-populate the settings for the next. This reduces staff time and the risk of data entry errors, and the use of these technologies has already been clearly demonstrated to improve outcomes. Femtosecond surgery is today where phaco was around 1990. We have already seen meaningful improvements through software and hardware upgrades in our existing machinery that have increased both the safety and durability of these instruments, and the next generation of lasers is already being tested in the preclinical setting.
To be sure, there are many facilities where acquiring a femtosecond laser is unrealistic. Simpler, less expensive means of reproducibly creating capsulotomies will have value for many surgeons. The market speaks to every new technology, and it’s likely there will be broad support for these promising, more affordable approaches. Still, the standard by which they will all be measured will continue to be the femtosecond laser.
Disclosure: Hovanesian reports he is a consultant for Alcon, AMO and Bausch + Lomb.