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R obert Rivera, MD, of Hoopes Vision in Draper, Utah, spoke about his top 5 pearls for maximizing outcomes in today's laser-assisted cataract surgery (LACS) practice at an EyeWorld education symposium at the ASCRS•ASOA Symposium & Congress. "For so many years, we talked our patients out of the belief that cataract surgery was done with lasers. Now we find ourselves talking our patients into believing their cataract surgery should be done with a laser," said Dr. Rivera. When speaking about reasons why physicians would want LACS for their patients, he listed the following reasons: • Precision and standardization of corneal incisions across multiple surgeons • Precision of capsulotomy, including size and centration of the limbus, pupil, and capsule, and improvements in effective lens position. • Softening of the nucleus to minimize phaco Dr. Rivera said that some doc- tors not performing LACS have the "perfect surgeon" mentality. "Some doctors believe they perform cataract surgery flawlessly or that the femtosecond laser doesn't do anything better than can be performed by hand. Others may consider the femtosecond an expensive 'toy,' or that their results are already as good as is possible," he said. The good news is that the most recent LACS technology addresses most of these concerns. Many of these doctors have not seen the latest LACS lasers in action, not learned to adapt, and may be left behind if they continue to wait. Once a decision has been made to introduce LACS into a practice, it is critical to set appropriate expectations and make the necessary adjustments for success. Dr. Rivera has learned several lessons from his LACS experiences to date: • The laser won't sell itself; proper patient education and counseling is key. • A public bias already exists in favor of laser. • Patients may not understand premium IOLs. • Everybody knows laser is better. • The largest percentage of patients opting for LACS is actually the monofocal group. • Post-refractive patients are already familiar with out-of-pocket payments for premium results. He shared his 5 top pearls for a practice considering or in the process of integrating LACS. Robert Rivera, MD Top 5 pearls for integrating LACS into a refractive cataract practice " Dr. Rivera tells his patients that LACS makes the procedure easier on them, as well as the surgeon." Robert Rivera, MD 4 Treatment planning options with laser cataract surgery Axial view of the OCT planning of a lens ablation continued on page 7 May 2014

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