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6 EW San Francisco 2013 Sunday, April 21, 2013 6 Please refer to pages 7 and 8 for important safety information about the Alcon products described in this supplement. Incorporating the LenSx Laser and the SoftFit Patient Interface upgrade Y ou can't sell something to a patient that you don't believe in yourself—espe- cially when you're asking a patient to pay out of pocket. I can confidently say that of all the femtosecond lasers that I have used or evaluated, the LenSx Laser (Alcon, Fort Worth, Texas) is the easiest to use. My advice to surgeons who are not yet using a femtosecond laser for their advanced technology lens patients is to do your homework and determine how to integrate it into your workflow and your center, but do not let pric- ing become the motivator. In my practice, I determined the price of the laser could be offset by the additional fees I charge patients for advanced technology lens implanta- tion. For my business model, that was preferable to negotiating with a surgery center for time and use of the laser and the OR. Managing patient flow There is some initial adjustment in figuring out your patient flow with the femtosecond laser. Having a staff member solely dedicated to running this part of the surgery will help smooth the flow and may even save time down the road. At our center, the patient is marked and under the laser even before I walk in. Of my cataract surgery patients, about half opt for the upgrade packages that include the LenSx Laser, so it's a sim- ple matter of every other patient is a LenSx Laser patient. Because of how smoothly our laser suite functions, I've been able to limit the additional time the laser portion takes to about 20-30 minutes daily. For the finan- cial rewards that are associated with this technology, I think the invest- ment is worthwhile. One tip that's worked for me: I started scheduling "right eye femtosecond days" and "left eye femtosecond days." It took a little while to get accustomed to the new flow, but it cut down on my needing to be directed to a particular room. Educating staff, talking with patients Even after you're comfortable with the laser, the staff and the patients are going to make the investment a successful one. Getting office staff to be enthusiastic about the technol- ogy is essential—energize your staff about the laser and about advanced technology lenses. Once the staff is comfortable dis- cussing the advanced technology lenses, discussing a premium laser technology is simply a matter of telling the patient there's an option for bladeless cataract surgery as well. Pa- tients already believe laser technology makes any surgery better and more precise, so I've found that part of the discussion is actually rather easy. SoftFit Interface: Improved comfort Patients rarely complained about any discomfort during the proce- dure, but a new interface on the LenSx Laser is making patient com- fort a priority. Dubbed the SoftFit Patient Interface (Alcon), there's now a soft, curved contact lens that allows for the natural curvature of the cornea to conform to a soft contact lens insert. It is designed to reduce corneal folds and corneal distortion to create a pristine, free- floating capsulotomy, and improve lens fragmentation while reducing energy use. There are also advantages to the image-guided OCT because the SoftFit Patient Interface reduces dis- tortions to the cornea, allowing for a better view and delivery of the laser. Alcon has conducted an IRB study that demonstrated that the reduced corneal distortion with the SoftFit Patient Interface is largely responsi- ble for the more pristine, full-thick- ness cut of the capsulotomy in nearly every case. 1 I have also found that proce- dures using the SoftFit Patient Interface fragment dense nuclei better, which allows me to use less Dubbed the SoftFit Patient Interface, there's now a soft, curved contact lens that allows for the natural curvature of the cornea to conform to a soft contact lens insert. Source: Alcon ultrasound energy for lens fragmen- tation. In my hands, I've noticed significantly less cell and flare in the anterior chamber as well as less corneal edema postoperatively, and this has led to my femtosecond cataract patients seeing better, faster. Before using the LenSx SoftFit Patient Interface upgrade, my LenSx Laser treatments took about 50-55 seconds, but the procedure time has been almost cut in half, to about 30 seconds in my hands. A laser refractive cataract procedure When you introduce an innovative technology like the LenSx Laser, your entire procedure is bound to change, and surgeons must be pre- pared for this. I have found I now have a surgeon factor/A constant for LenSx Laser patients and one for tra- ditional cataract patients. Another aspect leading to a new procedure is that with femtosecond-created arcu- ates, there is no universal suggested nomogram to perform the architec- ture of the arcuate incision. With the LenSx Laser we have a more pre- dictable effective lens position be- cause the capsulotomy is so perfect. 2 A worthwhile investment Overall, I would say that I've adopted and integrated this technol- ogy quite easily, and it's made my cataract practice more efficient and effective. For patients, the laser sur- gery makes intuitive sense, and its non-invasiveness and comfort makes for a fast, easy surgery and re- covery. As this technology continues to evolve and offer upgrades, it will provide even better ease of use and patient comfort. I encourage sur- geons considering this equipment to talk to other surgeons who have successfully incorporated the LenSx Laser into their practices. Once sur- geons work out the logistics and the learning curve, this technology will offer a distinct value to the surgeon, the practice, and the patients. References 1. Multicenter prospective clinical study (n-197 eyes); Alcon data on file. 2. Cionni, R. "Comparison of Effective Lens Position and Refractive Outcome: Femtosecond Laser vs. Manual Capsulotomy." Presented at the 2011 American Academy of Ophthalmology Refractive Sub-Specialty Day. Dr. Bowers is in private practice in Paducah, Ky. She can be contacted at 270-415-0245. Enhanced comfort, improved patient flow by Barbara Bowers, MD Barbara Bowers, MD " With the LenSx Laser we have a more predictable effective lens position because the capsulotomy is so perfect. " Watch this video on your smartphone or tablet using your QR code reader. (Scanner available for free at your app store.) Alcon Sunday_SF2103 8pages-DL2_Layout 1 4/20/13 8:12 PM Page 6

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