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Archive Surgery's Hottest Trends 2014

Eyeing the Potential Of Laser Cataract Surgery

Improved outcomes might lead to more widespread use of the game-changing technology.

James Salz, MD


laser portion of cataract surgery FIRST STOP James Salz, MD, performs the laser portion of cataract surgery at his Los Angeles facility.

Standardized results. Less collateral damage. Better IOL placement. What's not to like about the latest innovation to cataract surgery? Femtosecond lasers are far from the current standard of care for one of surgery's most common procedures, but more physicians might consider using the technology when competition among manufacturers slashes start-up costs and savvy patients with expendable income seek out facilities equipped with eye surgery's next big thing.

A phaco-free future?
Femtosecond lasers use short pulses of energy to make precise cuts in the cornea that are unmatched by even the most skilled blade-wielding surgeons. The most important part of cataract surgery involves making the capsulorhexis, which the laser does perfectly almost every time.

Each laser system has its strong points. All are excellent, although surgeons might prefer the imaging capabilities of one to another. That's a crucial difference for surgeons, too. They need to gauge the thickness of cataracts, know how far below the cornea the laser will perform the capsulorhexis, and soften and pre-chop the lens nucleus. This requires working with a laser system that has excellent imaging capabilities.

Before laser procedures, patients are prepped as they are for conventional surgery. Instead of heading directly into the OR, however, they stop in a dedicated room for the laser portion of the procedure. Cycling patients through the laser treatment might add several minutes to overall procedure times, so high-volume surgeons might opt against using the laser.

We do at least 300 cataracts a month in 4 ORs, and have 2 systems located in a separate room, so using the laser doesn't slow patient flow. That's a crucial setup in order to maintain case efficiencies — surgeons whose primary focus is manual surgery, and who only perform the occasional laser case, aren't slowed by laser procedures performed in the OR.

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