aao media briefing laser assisted cataract surgery october 25 2009 san francisco ca
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AAO Media Briefing Laser Assisted Cataract Surgery October 25, 2009 San Francisco, CA William W. Culbertson, MD Professor of Ophthalmology Bascom Palmer Eye Institute – Miami, Florida Interests: Cataract and Refractive Surgery (LASIK) Financial Relationships:

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william w culbertson md
William W. Culbertson, MD
  • Professor of Ophthalmology
  • Bascom Palmer Eye Institute – Miami, Florida
  • Interests: Cataract and Refractive Surgery (LASIK)
  • Financial Relationships:

- Optimedica (Santa Clara, CA): Consultant

- Abbott Medical Optics (Santa Ana, CA): Consultant

- Carl ZeissMeditec (Dublin, CA): Consultant

- Alcon (Fort Worth, TX): Speaker

contemporary cataract surgery
Contemporary Cataract Surgery

Steps:

  • Incision
  • Capsulorhexis
  • Phacoemulsification
  • IOL Insertion
  • Relaxing Incisions (Astigmatism)

Eyemaginations

Cartoon of Cataract surgery

1 Minute (runs with video below)

Video of Cataract Surgery 1.0 minute

potential problems in contemporary cataract surgery
Potential Problems in Contemporary Cataract Surgery:

Steps:

Incision

Capsulorhexis

Phacoemulsification

IOL Centration

Relaxing Incisions (Astigmatism)

Leaking wound and endophthalmitis

potential problems in contemporary cataract surgery5
Potential Problems in Contemporary Cataract Surgery:

Steps:

Incision

Capsulorhexis

Phacoemulsification

IOL Centration

Relaxing Incisions (Astigmatism)

potential problems in contemporary cataract surgery6
Potential Problems in Contemporary Cataract Surgery:

Steps:

Incision

Capsulorhexis

Phacoemulsification

IOL Centration

Relaxing Incisions (Astigmatism)

Corneal Phaco Burn

Phaco burn picture

potential problems in contemporary cataract surgery7
Potential Problems in Contemporary Cataract Surgery:

Steps:

Incision

Capsulorhexis

Phacoemulsification

IOL Centration

Relaxing Incisions (Astigmatism)

Decentered Multifocal IOL

Decentered IOL

potential problems in contemporary cataract surgery8
Potential Problems in Contemporary Cataract Surgery:

Steps:

Incision

Capsulorhexis

Phacoemulsification

IOL Centration

Relaxing Incisions (Astigmatism)

Decentered Multifocal IOL

Decentered IOL

potential problems in contemporary cataract surgery9
Potential Problems in Contemporary Cataract Surgery:

Pre-op LRIs

Steps:

Incision

Capsulorhexis

Phacoemulsification

IOL Centration

Relaxing Incisions (Astigmatism)

Post-op LRIs

history of laser cataract surgery
History of “Laser Cataract Surgery”
  • YAG laser lens softening
  • Dodick laser
  • Phoenix Laser
femtosecond laser in ophthalmology
Femtosecond Laser in Ophthalmology
  • Corneal Surgery

Lasik flaps

Corneal transplants

(Corneal relaxing incisions)

(Cataract surgery incisions)

  • Companies doing corneal surgery with fs laser:

AMO (Intralase)

Technolas (FEMTEC Perfect Vision)

Zeimer (LDV)

Zeiss (Visumax)

slide13

Femtosecond Laser Photodisruption

  • Plasma expansion
  • Shock wave pressure
  • Cavitation bubble creation
  • Decreased pulse duration reduces photodisruption threshold and secondary effects allowing closer placement of pulses

Initial

Beam

Cavitation

Bubble

femtosecond laser assisted cataract surgery flacs
Femtosecond Laser-Assisted Cataract Surgery (FLACS)

Three American Companies:

LensAR (Winter Park, FL)

LenSx (Aliso Viejo, CA)

Optimedica (Santa Clara, CA)

femtosecond laser assisted cataract surgery flacs15
Femtosecond Laser-Assisted Cataract Surgery (FLACS)

Objectives:

  • Increase safety
  • Improve precision
  • Automate undependable components
femtosecond laser assisted cataract surgery flacs16
Femtosecond Laser-Assisted Cataract Surgery (FLACS)

Laser Assisted Steps:

  • Imaging of the front of the eye
  • Cataract incision
  • Capsulorhexis (anterior capsulotomy)
  • Cataract (lens nucleus) segmentation and softening
  • Limbal relaxing incisions
fs laser assisted cataract surgery imaging and registration
FS Laser-assisted Cataract SurgeryImaging and Registration:

OCT Technique (Optimedica)

Scheimpflug Technique (LensAR)

cataract incision
Cataract Incision:

(Optimedica)

fs laser assisted cataract surgery cataract incision20
FS Laser-Assisted Cataract Surgery:Cataract Incision:

Cartoon of incision

Video of incision

capsulorhexis
Capsulorhexis:

(Optimedica)

fs laser assisted cataract surgery advantages and disadvantages
FS Laser-assisted Cataract Surgery:Advantagesand Disadvantages:
  • Advantages:
  • Improved safety
  • Increased precision
  • Enhanced reproducibility
  • Disadvantages:
  • Increased Cost
  • Added time
conclusion
Conclusion:

Femtosecond laser assisted cataract surgery is a promising improvement on standard contemporary phacoemulsification cataract surgery.

fs laser assisted cataract surgery the future
FS Laser-Assisted Cataract Surgery:The Future:
  • Sub Bowman’s Relaxing Incisions
  • Complex Cataract Incisions
  • Customized Capsulorhexis
  • Capsulorhexis Integrating with IOLs

- “Capsule in the Lens”

- Toric IOL Orientation

  • Lens Refilling Surgery
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