Abstract
Perhaps the most significant advance in Ophthalmology to date in the new twenty-first century is the use of femtosecond (FS) lasers for lens replacement surgery [1]. There are many potential benefits that may arise with FS laser technology. I suspect that patients will benefit from FS laser technology as we anticipate a lower complication rate than currently associated with standard cataract surgery. Current vitreous loss rates range from 2 to 6 % of all cases. Wouldn’t reducing phaco time with the laser and avoiding a manual capsulorhexis reduce the rate of vitreous loss? Patients want this potentially improved safety as well as freedom from glasses if possible, (the goal of refractive surgery). The FS laser can also contribute to this refractive goal for lens surgery patients. It is time we provided better uncorrected distance visual acuity (UCDVA) to our cataract patients. Results from current IOL studies pale next to LASIK results (40 % 20/40 UCDVA compared to 90 % with LASIK) [2]. The ability of the laser to make precise, reproducible corneal incisions and capsulotomies will allow surgeons to optimize lens position, more effectively manage preexisting astigmatism, and possibly even reduce induced astigmatism. I believe that the laser will enable us to improve refractive results with such reproducible incisions. We may learn that we are able to improve and quantify the effective lens position of an IOL by controlling the size, centration, and shape of a laser capsulorhexis. Ophthalmologists will be able to make corneal astigmatic incisions with the laser to address preexisting cylinder and further improve postoperative refractive results. We now have the opportunity to learn what we do not know regarding the clinical significance of precisely sized and positioned incisions and capsulotomies. For how are we able to study these steps if we cannot provide a reproducible benchmark? Thus, I believe that this technology represents the perfect marriage of the cataract and refractive subspecialties.
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Slade, S.G. (2013). Step-By-Step: Starting Your ReLACS Practice. In: Krueger, R., Talamo, J., Lindstrom, R. (eds) Textbook of Refractive Laser Assisted Cataract Surgery (ReLACS). Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1010-2_13
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