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What do the recent technological advancements for femto cataract surgery mean? themselves, they can manipulate the laser and go through the steps by manipulating the trackball. However, if they prefer to have an assistant perform the steps, the assistant can do so by using the touch screen and verbal instructions from the surgeon. Additionally, the graphic user interface (GUI) moves the surgeon through the entire planning and execution process. The surgical plan automatically comes up on the screen so that the surgeon can double-check it with other information he or she may have written down or on another computer. Another benefit of the system is autocentration. For ex- ample, the surgeon can choose whether the capsulorhexis will be centered over the dilated pupil or centered on the line of sight. The system makes these kinds of choices available, and it autocenters the rhexis based on the surgeon's preference. When paired with Verion, the LenSx Laser can do autocentra- tion of all laser treatments based on the preoperative undilat- ed pupil. Automation of the femtosecond laser gives surgeons an edge in terms of being able to predictably, confidently, and precisely perform the various initial steps of the procedure. This provides the consistency to help ensure a successful pro- cedure. Additionally, the cases that I perform with the LenSx Laser are truly less stressful to me than the cases that I perform manually from beginning to end. The incisions are uniform with the femtosecond laser compared to some variability that I have when I create incisions myself with either a diamond or a metal knife. As I mentioned previously, surgeons can make the capsulorhexis perfectly round, place it exactly where they want it, and make it exactly the size they want it every time. Many surgeons are excellent at making a capsulorhexis, but no surgeon can make them exactly the same, of the desired size and in the desired location time after time. A recent study has found that a continuous curvilinear capsulorhexis created with a femtosecond laser results in a more stable refractive result and less IOL tilt and decentration than a manual continuous curvilinear capsulorhexis. 1 In this prospective, randomized study, a laser continuous curvilinear capsulorhexis was performed in 20 eyes, and a manual contin- uous curvilinear capsulorhexis was performed in 25 eyes. Horizontal and vertical tilt were statistically significantly higher in the manual group, and lenses implanted after manual continuous curvilinear capsulorhexis showed greater horizontal and total decentration. Finally, the LenSx Laser gives us the ability to perform the lens chop, which makes removal of the lens easier. The After conquering the learning curve, the LenSx Laser (Alcon, Fort Worth, Texas) can improve time efficiency and patient flow in your office. How to best incorporate this technology will vary a bit from practice to practice. Optimally, each prac- tice should attempt to disrupt the flow that has worked well in the past as little as possible. The amount of flow change and possible disruption that takes place will depend on two factors: whether you operate out of one room or two and where you plan to place the laser. In my practice, because we only have one operating room, we found that it was much more efficient to place the laser outside the operating room in a clean, adjacent room, so that there is very little travel time from the LenSx Laser room to the operating room. Before we had the LenSx Laser, we had a system where we always had the next patient ready to go so that one patient was essentially being wheeled out of the oper- ating room as the next one was being wheeled in. It was a very efficient system; however, the LenSx Laser has some operating time involved with it, so we had to make some adjustments. We have been able to overcome the flow challenges by having staff prepare a LenSx Laser case at the same time that another patient is being brought into the operating suite. In other words, our office staggers LenSx Laser cases with non- LenSx Laser cases so that the operating room is always full, just as it was before we had the laser. For example, I will finish with a case in the operating room and go directly to the LenSx Laser room where a patient is already prepped and underneath the laser. While I am performing the LenSx Laser procedure, another patient is being wheeled into the operating room and is being prepped and draped. When the LenSx Laser procedure is completed, the second patient is in the operating room waiting for me to operate. The just-completed LenSx Laser patient is put into a holding bay and will be the next patient to go into the operating room. This makes our ASC extremely efficient. A major advantage of the LenSx Laser platform is that there is no fixed bed. The patient can stay on the same oper- ating bed for the laser portion of the procedure as well as for the intraocular portion of the procedure that takes place in the operating room. The patient never has to leave the bed and can be easily moved/wheeled from one location to another, optimizing the type of flow pattern described above. With regard to the procedure itself, the LenSx Laser is quite easy to use. The screen is very intuitive in terms of the sequence of steps from the beginning to the end of the procedure. Surgeons use a combination of a touch screen or a trackball. For those surgeons who like to do everything by Stephen Lane, MD Advances to the LenSx Laser improve efficiency in the office 6 For important product information, please see page 8.

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