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Using a femtosecond laser for arcuate and clear corneal incisions increases precision W hen we think about using a femtosecond laser for cataract surgery, we've been taught to think about the femtosecond laser as a kind of "fancy blade." The femtosecond laser can certainly simulate a fancy blade, but its other attributes are what make these lasers so intriguing. They will allow the surgeon to create incisions that were previously unimaginable and unattainable. We have just begun to scratch the surface of the femtosecond lasers' capabilities. Currently, there are three types of femtosecond lasers for cataract surgery—ones developed solely for cataract surgery (Catalys, OptiMedica, Sunnyvale, Calif.; LENSAR, Orlando, Fla.), those that have been developed primarily for laser cataract surgery, but can also create LASIK flaps (LenSx, Alcon, Fort Worth, Texas; Victus, Bausch + Lomb/Technolas, Rochester, N.Y.), and one that was developed for LASIK but can create arcuate inci- sions (IntraLase iFS, Abbott Medical Optics, Santa Ana, Calif.). My laser is located at a dedi- cated laser refractive facility about 2 miles away from my cataract surgery center. We create both partial thick- ness arcuate incisions and full-thick- ness clear corneal incisions at the laser facility; the patient then returns to our cataract facility later the same day for cataract surgery. We open the incisions at our cataract center rather than at the laser facility. My first impression of IntraLase- created cataract incisions was they are high quality, precise, and repeat- able. Many surgeons believe a Langerman style three-plane inci- sion is a better sealing incision, but they are a challenge to create manu- ally. During my initial case series with the IntraLase, these incisions were created with ease and sealed extremely well. Financial considerations for femtosecond cataract surgery For cataract-only surgeons who do not own a refractive laser, using these can be as simple as coordinat- ing with a laser refractive surgery laser center. There's no upfront, out-of-pocket cost to the cataract specialist to use a femtosecond laser at a non-competitive site, and user fees are nominal. From the laser refractive surgery center's perspective, letting cataract surgeons use their laser is a way of incrementally increasing revenue. I have performed femtosecond intrastromal arcuate incisions with the IntraLase and watched the pa- tient walk across the street to hit the gym. The patient left my laser sur- gery center without eye drops and without pills. This is—potentially—a completely new way of handling creating corneal incisions for cataract surgery. Cataract surgeons who want to enter the laser refractive cataract sur- gery market now have an option to do so with very little financial risk. Dr. Waltz is in private practice, Eye Surgeons of Indiana. He is a partner, Surgical Care Center, Indianapolis, and surgical director, Medical Missions, VOSH Indiana. He can be contacted at kwaltz56@gmail.com. by Kevin L. Waltz, OD, MD Corneal applications of laser cataract surgery " Corneal incisions created with the IntraLase are high quality, precise, and repeatable. " Kevin L. Waltz, OD, MD 10 EW San Francisco 2013 Saturday, April 20, 2013 The different types of incisions a femtosecond laser can make Source: Abbott Medical Optics AMO Saturday supplement_SF2013-dl.qxp_Layout 1 4/19/13 11:29 PM Page 10

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