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Femtosecond-Laser Assisted Cataract Surgery: Is it living up to the hype?. 117 th Annual Meeting of the American Academy of Ophthalmology Press Briefing Nov. 18, 2013. Introduction of Speakers. Bret L Fisher, M.D., medical director of the Eye Center of North Florida

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femtosecond laser assisted cataract surgery is it living up to the hype

Femtosecond-Laser Assisted Cataract Surgery: Is it living up to the hype?

117th Annual Meeting of the American Academy of Ophthalmology

Press Briefing

Nov. 18, 2013

introduction of speakers
Introduction of Speakers
  • Bret L Fisher, M.D., medical director of the Eye Center of North Florida
    • Visual Acuity and Predictability in Femtosecond Laser Cataract Surgery With Intraoperative Aberrometry
  • Mike P Holzer, M.D., vice chairman and director of refractive surgery, Department of Ophthalmology, University of Heidelberg, Germany
    • Single-center Contralateral Evaluation of Femtosecond Laser Cataract Surgery Compared with Manual Cataract Surgery
  • Tim Schultz, M.D., Department of Ophthalmology, University Hospital Bochum, Germany
    • Toward the Elimination of Ultrasound With Femtosecond Laser Cataract Surgery
slide3

Visual Acuity and Predictability in Femtosecond Laser Cataract Surgery With Intraoperative Aberrometry

Presented by: Bret Fisher, M.D.

The Eye Center of North Florida

Panama City, FL

financial disclosures
Financial Disclosures
  • Alcon - Consultant and Lecture Fees
purpose
Purpose
  • To determine the impact of intraoperative aberrometry on uncorrected visual acuity and predictability (MAVPE) in Femtosecond laser cataract surgery
background

Outcomes analysis in the literature

      • Narvaez / Stulting JCRS Dec. 2006
        • 643 eyes
          • 46 % within 0.50 D of formula predicted target
          • MAVPE: 0.52 D ± 0.44 D
      • Gale et al, Eye Aug. 2007
        • 4806 eyes (2688 in the PCI group)
          • PCI group results
            • 55 % of eyes within 0.50 D of formula predicted target
            • 85% of eyes within 1.00 of formula predicted target
            • MAVPE: 0.55D ± 0.55D
      • Behndig et al, JCRS July 2012
        • 17,506 case (performed between 2008-2010)
          • 55% achieved refractive target (0.00 D sphere ,<1.00 D of astigmatism
          • MAVPE: 0.50 D ± 0.34 D
Background
method
Method
  • One surgeon
  • No postrefractive cases
  • Retrospective analysis of eyes within the following groups:
    • Group 1 – Consecutive cases that had cataract surgery with IOL implantation utilizing a femtosecond laser (LenSx®) without intraoperative wavefront aberrometry (ORA System®)
    • Group 2 – Consecutive cases that had cataract surgery with IOL implantation utilizing a femtosecond laser (LenSx) in combination with intraoperative wavefront aberrometry (ORA System)
baseline characteristics group 1 femtosecond laser only
Baseline CharacteristicsGroup 1 – Femtosecond Laser Only
  • 55 eyes of 55 patients
    • 23 of 55 (42%) male
    • 32 of 55 (58%) female
baseline characteristics group 2 femtosecond laser and intraoperative aberrometry
Baseline CharacteristicsGroup 2 – Femtosecond Laser and IntraoperativeAberrometry
  • 66 eyes of 50 patients
    • 22 of 50 (44%) male
    • 38 of 50 (56%) female
slide11
Uncorrected Distance Visual Acuity (UCDVA) Results Group 1 - Femtosecond Laser Only Eyes Targeted for Distance

n = 49 eyes

*Eyes targeted for distance only

slide13
Uncorrected Distance Visual Acuity (UCDVA) Results Group 2 - Femtosecond Laser and IntraoperativeAberrometry

n = 66 eyes

slide14
Uncorrected Distance Visual Acuity (UCDVA) Results Group 2 - Femtosecond Laser and IntraoperativeAberrometry

n = 60 eyes

*Eyes targeted for distance only

slide15
Mean Absolute Value Prediction Error (MAVPE) ResultsGroup 2 – Femtosecond Laser and Intraoperative Aberrometry

n = 66 eyes

advances in intraoperative aberrometry ora system with verifeye
Advances in Intraoperative Aberrometry ORA System with VerifEye
  • Function: Provides streaming refractive information to the surgeon during preview (prior to measurement)
  • Provides: High quality measurements
    • Verifies that the eye is stable and ready for measurement
  • Result: Greater consistency and accuracy
      • IOL power recommendations
      • Guidance for astigmatic measurements
  • Shorter measurement time
      • Faster processor
        • 2 seconds for measurement
        • 3 seconds for processing
mean absolute value prediction error mavpe results group 2 femtosecond laser and ora with verifeye
Mean Absolute Value Prediction Error (MAVPE) ResultsGroup 2 – Femtosecond Laser and ORA with VerifEye

n=26 eyes

summary
Summary
  • Femtosecond laser (FSL) assisted cataract surgery provided refraction outcomes that are better that those reported in literature
  • FSL combined with Intraoperative aberrometry provided better UDVA than FSL alone
    • Difference in mean acuity is statistically significant (p<0.03)
  • FSL combined with Intraoperative aberrometry provided better refractive outcomes (as measured by MAVPE) than FSL alone
    • Difference in mean acuity is statistically significant (p<0.04)
conclusion
Conclusion
  • Preliminary results suggest that intraoperative aberrometry can improve results with Femtosecond laser cataract surgery
  • Proposed addition evaluation
    • Included a non FSL, non ORA group
    • Include an ORA only group