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Femtosecond-Laser Assisted Cataract Surgery: Is it living up to the hype?

Femtosecond-Laser Assisted Cataract Surgery: Is it living up to the hype?. 117 th Annual Meeting of the American Academy of Ophthalmology Press Briefing Nov. 18, 2013. Introduction of Speakers. Bret L Fisher, M.D., medical director of the Eye Center of North Florida

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Femtosecond-Laser Assisted Cataract Surgery: Is it living up to the hype?

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  1. Femtosecond-Laser Assisted Cataract Surgery: Is it living up to the hype? 117th Annual Meeting of the American Academy of Ophthalmology Press Briefing Nov. 18, 2013

  2. Introduction of Speakers • Bret L Fisher, M.D., medical director of the Eye Center of North Florida • Visual Acuity and Predictability in Femtosecond Laser Cataract Surgery With Intraoperative Aberrometry • Mike P Holzer, M.D., vice chairman and director of refractive surgery, Department of Ophthalmology, University of Heidelberg, Germany • Single-center Contralateral Evaluation of Femtosecond Laser Cataract Surgery Compared with Manual Cataract Surgery • Tim Schultz, M.D., Department of Ophthalmology, University Hospital Bochum, Germany • Toward the Elimination of Ultrasound With Femtosecond Laser Cataract Surgery

  3. Visual Acuity and Predictability in Femtosecond Laser Cataract Surgery With Intraoperative Aberrometry Presented by: Bret Fisher, M.D. The Eye Center of North Florida Panama City, FL

  4. Financial Disclosures • Alcon - Consultant and Lecture Fees

  5. Purpose • To determine the impact of intraoperative aberrometry on uncorrected visual acuity and predictability (MAVPE) in Femtosecond laser cataract surgery

  6. Outcomes analysis in the literature • Narvaez / Stulting JCRS Dec. 2006 • 643 eyes • 46 % within 0.50 D of formula predicted target • MAVPE: 0.52 D ± 0.44 D • Gale et al, Eye Aug. 2007 • 4806 eyes (2688 in the PCI group) • PCI group results • 55 % of eyes within 0.50 D of formula predicted target • 85% of eyes within 1.00 of formula predicted target • MAVPE: 0.55D ± 0.55D • Behndig et al, JCRS July 2012 • 17,506 case (performed between 2008-2010) • 55% achieved refractive target (0.00 D sphere ,<1.00 D of astigmatism • MAVPE: 0.50 D ± 0.34 D Background

  7. Method • One surgeon • No postrefractive cases • Retrospective analysis of eyes within the following groups: • Group 1 – Consecutive cases that had cataract surgery with IOL implantation utilizing a femtosecond laser (LenSx®) without intraoperative wavefront aberrometry (ORA System®) • Group 2 – Consecutive cases that had cataract surgery with IOL implantation utilizing a femtosecond laser (LenSx) in combination with intraoperative wavefront aberrometry (ORA System)

  8. Baseline CharacteristicsGroup 1 – Femtosecond Laser Only • 55 eyes of 55 patients • 23 of 55 (42%) male • 32 of 55 (58%) female

  9. Baseline CharacteristicsGroup 2 – Femtosecond Laser and IntraoperativeAberrometry • 66 eyes of 50 patients • 22 of 50 (44%) male • 38 of 50 (56%) female

  10. Uncorrected Distance Visual Acuity (UCDVA) Results Group 1 - Femtosecond Laser Only n = 55 eyes

  11. Uncorrected Distance Visual Acuity (UCDVA) Results Group 1 - Femtosecond Laser Only Eyes Targeted for Distance n = 49 eyes *Eyes targeted for distance only

  12. Mean Absolute Value Prediction Error (MAVPE) ResultsGroup 1 – Femtosecond Laser Only n = 55 eyes

  13. Uncorrected Distance Visual Acuity (UCDVA) Results Group 2 - Femtosecond Laser and IntraoperativeAberrometry n = 66 eyes

  14. Uncorrected Distance Visual Acuity (UCDVA) Results Group 2 - Femtosecond Laser and IntraoperativeAberrometry n = 60 eyes *Eyes targeted for distance only

  15. Mean Absolute Value Prediction Error (MAVPE) ResultsGroup 2 – Femtosecond Laser and Intraoperative Aberrometry n = 66 eyes

  16. Advances in Intraoperative Aberrometry ORA System with VerifEye • Function: Provides streaming refractive information to the surgeon during preview (prior to measurement) • Provides: High quality measurements • Verifies that the eye is stable and ready for measurement • Result: Greater consistency and accuracy • IOL power recommendations • Guidance for astigmatic measurements • Shorter measurement time • Faster processor • 2 seconds for measurement • 3 seconds for processing

  17. VerifEye

  18. Mean Absolute Value Prediction Error (MAVPE) ResultsGroup 2 – Femtosecond Laser and ORA with VerifEye n=26 eyes

  19. Summary • Femtosecond laser (FSL) assisted cataract surgery provided refraction outcomes that are better that those reported in literature • FSL combined with Intraoperative aberrometry provided better UDVA than FSL alone • Difference in mean acuity is statistically significant (p<0.03) • FSL combined with Intraoperative aberrometry provided better refractive outcomes (as measured by MAVPE) than FSL alone • Difference in mean acuity is statistically significant (p<0.04)

  20. Conclusion • Preliminary results suggest that intraoperative aberrometry can improve results with Femtosecond laser cataract surgery • Proposed addition evaluation • Included a non FSL, non ORA group • Include an ORA only group

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