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EW San Diego 2015 5 LenSx Laser shown with the Verion Digital Marker by Kerry Solomon, MD LenSx Laser: Advancing cataract surgery precision I n my experience, the LenSx Laser (Alcon, Fort Worth, Texas) makes cataract surgery more precise in a number of ways. First, by having high-defini- tion OCT, we are able to place the laser energy exactly where we want it to be. By using the OCT, we are achieving exactly what we intended: 80% or 85% depth and our incisions in the exact form and shape that we want. Similarly, with primary and secondary corneal incisions, as well as capsulotomies, we are able to image and precisely place the energy exactly where we want it. In the 4 years that LenSx Laser has been on the market, there have been numer- ous hardware and software upgrades that have allowed us to reduce the amount of energy needed. The advance of the SoftFit Patient Interface has allowed us to improve the overall procedure. My current procedure times are between 20 and 24 seconds, on average. We have dramatically reduced our time, improved our precision, and improved our accuracy. Adding the Verion Image Guided System (Alcon) as part of the surgical plan in the office has further automated treatments with the LenSx Laser. It takes a digital picture of the eye, which registers the scleral vessel patterns and iris landmarks, and develops a surgical plan. We transfer that plan from the office to the laser, and using the Verion System and the registered preoperative image of the eye, we are accounting for cyclotor- sion and cyclorotation of the eye. Now, we are placing incisions exactly where we intend to place them, which results in improved visual outcomes because we are controlling for variables such as the location of the primary incision, the location of the secondary incision, and the location of the arcuate incisions. We can also standardize our incision placement with each and every case, leading to a more controlled surgically induced astig- matism. The LenSx Laser is integrated very nicely with the Verion System. It creates the same size capsulotomy in every case. You can dial in exactly what size you want, and this adds another level of consistency. In the operating room, we use the Verion System to reorient the surgery so that everything is done in the exact same meridian. Finally, we add in- traoperative aberrometry in the form of the ORA System that allows us to fine tune the placement of toric intraocular lenses in the eye. Having these systems integrated allows us to improve our visual outcomes, which benefits our patients. All of this changes patient flow. While it adds time to both the office visit and the surgical procedure, it results in better outcomes at the end of the day, making that extra time worth it, in my opinion. In terms of the flow, patients get their preoper- ative planning done at the time of their cataract workup. That plan is delivered to the LenSx Laser for the laser portion of the procedure if the patient opted for that. First, we align the LenSx Laser with the Verion System to orient and properly align so that the surgical plan can be exe- cuted based on the plan developed in the office. That plan is then transferred to the operating room, where we reorient the eye with the Verion System so everything is once again realigned. Then the cataract is removed in whatever fashion we choose to use. I currently use the Centurion Vision System (Alcon), and I combine that with the femto- second laser, which presoftens the lens. This reduces the overall energy that I am delivering into the eye and also reduces the amount of fluid being used. I then take an aphakic measure- ment with intraoperative aber- rometry, which takes into account posterior corneal astigmatism and the total refractive power of the eye. I fine-tune the implant that I am going to use based on the spherical and cylindrical power. I use the Verion System to orient my toric lenses or to best center things in the case of multifocal lenses. Finally, I will confirm every- thing with intraoperative aber- rometry in the case of toric lenses and fine-tune the positioning until aberrometry tells me that I have the optimal lens position. Postoperative- ly, data can be entered into the Verion System or into the ORA System, and those data can be used to start optimizing your surgeon factors for IOL calculation formulas. All of that fits together with the end result of trying to improve outcomes for patients. Dr. Solomon is in practice in Charleston, S.C. He can be contacted at kerrysolomon@ me.com. " In the 4 years that LenSx Laser has been on the market, there have been numerous hardware and software upgrades that have allowed us to reduce the amount of energy needed " Kerry Solomon, MD

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