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7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Current Status of Femto-secondLaser Cataract Surgery
Dr. Vidushi Sharma, MBBS (AIIMS),MD (Ophthalmology,
AIIMS, New Delhi),FRCS (UK)
Dr. Suresh K Pandey,MS (Ophthalmology, PGIMER, CHANDIGARH),
Anterior Segment Fellowship (USA)
SuVi Eye Hospital & Research CentreC-13, TALWANDI, KOTA, RAJASTHAN, INDIA
Phone + 91 9351412449Email- [email protected]
www.suvieye.com, www.phacolasiktraining.com
mailto:[email protected]://www.suvieye.com/http://www.suvieye.com/mailto:[email protected]7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Instruction Course during APAO AIOS 2013meeting
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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The authors haveno financial interest
in the subjectmatter of thispresentation
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Femto-laser Cataract Surgery
Trying to improve on the existingexcellent results
Paradigm shift
Comes with a huge price tag
Recurring costs of disposableequipments, maintenance costs (andclick fees)
Dr. Vidushi, MD, FRCS, SuVi Eye Institute, Kota, India
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Current Femto-cataract platforms
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Global Market share
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Perfectly centred &sized capsulotomy (IOLtilt & decentration)
Liquify, soften orchop the lens(reducing phaco energy
needed)
Precise corneal relaxingincisions
Incisions with perfectdimensions andarchitecture
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Femto Laser cataract
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Optimedica Docking
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
10/41Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Repeatably precise capsulorhexis
Specialy useful in difficult cases like smallpupils, poor red glow and weak zonules
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Nucleus management
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Cataract incisions
Create multi-planarincisions withbetter sealability
0/42 eyes wth 2-plane laser incisionneeded stromalhydration to seal(LenSx Steinert R)
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Cost
cost between $400,000 and$500,000.
usage fee between $150 and $400per eye
maintenance contracts between
$25,000 and $50,000 per year
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Differences from FS lasers for Lasik
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Docking Systems
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Imaging Systems
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Imaging Systems
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Comparison of Platforms
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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LenSx (Dr. C. Wavikar will share his experience)
First laser to getapproved for lasercataract surgery
Maximuminstallations allover the world
and Maximumeyes performed
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Victus (Dr K P Reddy will share his Experience)
Single platformfor refractiveand cataract
indications,though notapproved for all
uses Real time OCT
imaging
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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LensAR
3-D confocal structured illumination(CSI) for imaging (based onScheimpflug principle)
Auto-measures and locates allsurfaces for treatment planning
noncorneal contact liquid patientinterface device filled with BSS
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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OptiMedica
Liquid OpticsInterface
Integrated OpticalCoherence
Tomography(OCT) system
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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But....
Real clinical benefits vs technological
Price tag and recurring costs
Worth the additional expense
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Transformative tool.......
Or extravagant toy for few?
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Problems
Increased chair time,heightened patient expectations
Lack of data showing significantimprovement in functional visualoutcomes such as better uncorrectedvisual acuity
Improvement of 1-2 % significant
Slows down surgeries
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Femtolaser cataract procedure
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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What can be expected
If 92 percent within 0.5D ofemmetropia & 96 percent have 20/20vision or better, how much better can
you make it with a perfectly circularcapsulorhexis? (Its a bit like weighing theingredients of your cake down to the last microgram intellectually interesting but nobody can taste the difference)
Limitations of biometry and IOLcalculations
IOLs come in 0.5D steps
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Premium IOLs
femtosecond is hoped to improveresults with multifocal andaccommodative IOLs
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Multifocal & Accommodating IOLs
How many ophthalmologists wouldactually get a multifocal/accommodative IOL implanted in theirown eye as of today
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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What we need to know
Perhaps one day this will becomestandard of care, but is today that day?
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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New Set of problems
Its own learning curve
About 3 minutes of suction to performall of its steps, petechial hemorrhages
can weld the capsule to underlyingcortex, making hydrodissection moredifficult.
laser cuts of cortical material makeaspiration of cortex more difficult,potentially increasing PCO rates
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Parallels
Compared to introduction ofphacoemulsification
Also compared to introduction of IOLs But both of these underwent many
modifications to become universally
acceptable Essentially automation of a few steps
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Parallels
Intralase Femtosecond Laserintroduced in 2001 market share of
fs lasers purchased for LASIK flapcreation55 percent in 2010 realdemonstrable better visual results?Do patients pay the extra amount
Dodick laser
Fugo Blade
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Lessons from US
Cost matters decreased Medicare
payments, healthcare crisis
India - Move to have surgical rates
displayed moving to greater control
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Kind of marketing
The Hindu Feb 25 2012 While persons who undergo conventional cataract
operation needed to rest their eyes for a minimumof ten days, those who undergo the Femtosecond
laser procedure can start work immediately
Femtosecond 1,000 times more precise with littlescope for human error
Earlier laser vision correction surgery was possible
only if the thickness of the cornea was more then450 microns thick, but now the laser surgery couldbe performed on persons with corneal thickness ofless then 450 microns with new equipment
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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My Conclusions
Wait and watch
Latest gizmo in town, Me too
Depends on type of practice groups
No need to feel pressured as of now
The surgeons who can afford it dontreally need it but will help inrefinements for the future!
Dr. Vidushi, MD, FRCS, APAO-AIOS 2013
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Thank You
7/23/2019 Update on Femto-second Laser Cataract Surgery Dr Vidushi Sharma & Dr Suresh K Pandey, SuVi Eye Institute, Kota, India
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Current Status of Femto-secondLaser Cataract Surgery
Dr. Vidushi Sharma, MBBS (AIIMS),
MD (Ophthalmology,AIIMS, New Delhi),FRCS (UK)
Dr. Suresh K Pandey,MS (Ophthalmology, PGIMER, CHANDIGARH),
Anterior Segment Fellowship (USA)
SuVi Eye Hospital & Research CentreC-13, TALWANDI, KOTA, RAJASTHAN, INDIA
il i @ il
mailto:[email protected]:[email protected]