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4 Advancing astigmatic keratotomy gives us the confidence to treat not only higher but lower degrees of astigmatism (Figure 1). We anticipate continued improve- ments and innovations. Clinicians such as Dr. Eric Donnenfeld and Dr. Julian Stevens have developed femtosecond limbal relaxing incision (LRI) nomo- grams, and more are in development. When creating an astigmatic inci- sion with the Catalys Precision Laser System (Abbott Medical Optics, Abbott Park, Ill.) it takes only seconds, and we have full control in terms of the optical zone, depth, and other characteristics. Case report A 76-year-old woman presented to our clinic complaining of blurry distance vision, requesting an enhancement. She previously had cataract surgery in both eyes with monovision and a history of previous hyperopic LASIK before cataract emerging that show LACS may be superi- or in terms of safety and predictability in achieving target outcomes. Femtosecond lasers offer a number of potential benefits, including image guidance, femtosecond-enabled corneal incisions, capsulotomy, and fragmen- tation. A major benefit is the ability to perform femtosecond-assisted astigmatic incisions. Femtosecond laser-assisted astigmatic keratotomy In our practice, femtosecond laser tech- nology has allowed us to expand the range of candidates for astigmatic correc- tion, as well as candidates for multifocal intraocular lenses (IOLs). Villegas et al. used adaptive optics to study the minimum amount of percep- tible astigmatism that impacts visual acuity. They found that 0.3 D was visu- ally perceptible. We feel that precise and reproducible laser incision architecture Astigmatic correction is a key benefit of femtosecond technology R efractive laser-assisted cataract surgery (LACS) has been shown to be safe and effective. Its superiority in comparison with manual techniques has been debated, but more and more data are by George O. Waring IV, MD, FACS Dr. Waring is director of refractive surgery and assistant profes- sor of ophthalmology, Medical University of South Carolina, Storm Eye Institute, Charles- ton; medical director of Magill Vision Center, Mt. Pleasant; and adjunct assistant professor of bioengineering, College of Engineering and Science, Clemson University, Clemson, S.C. Figure 1. High-powered magnification slit lamp photo of femtosecond LRI Figure 2. Comparison of preoperative and postoperative tomography with femtosecond laser-assisted astigmatic keratotomy (FLAAK) Source: George O. Waring IV, MD, FACS continued on page 5

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