Femtosecond-Laser Assisted Cataract Surgery
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Transcript Femtosecond-Laser Assisted Cataract Surgery
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
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
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
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
Financial Disclosures
• Alcon - Consultant and Lecture Fees
Purpose
• To determine the impact of intraoperative
aberrometry on uncorrected visual acuity and
predictability (MAVPE) in Femtosecond laser
cataract surgery
Background
• 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
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)
Baseline Characteristics
Group 1 – Femtosecond Laser Only
• 55 eyes of 55 patients
• 23 of 55 (42%) male
• 32 of 55 (58%) female
Age
Preoperative
Flat K
Preoperative
Steep K
Preop
Keratometric
Cylinder
Axial
Length
White
to
White
Mean
69
42.99
43.86
0.87
24.31
12.11
Min
36
39.78
41.27
0
21.77
11.08
Max
82
46.62
47.4
6.34
29.69
13.1
Standard
Deviation
9
1.47
1.50
0.95
1.60
0.49
SN60WF
SN6AD1
SN6ATx
30 (55%)
17 (31 %)
8 (14 %)
Baseline Characteristics
Group 2 – Femtosecond Laser and Intraoperative Aberrometry
• 66 eyes of 50 patients
•22 of 50 (44%) male
•38 of 50 (56%) female
Age
Preoperative
Flat K
Preoperative
Steep K
Preop
Keratometric
Cylinder
Axial
Length
White
to
White
Mean
66
43.37
44.28
0.90
23.59
12.20
Min
22
39.56
39.95
0
21.31
11.44
Max
84
46.68
47.35
4.59
26.07
13.24
Standard
Deviation
11
1.45
1.63
0.70
0.95
0.44
SN60WF
SN6AD1
SN6ATx
26 (40%)
32 (48%)
8 (12%)
Uncorrected Distance Visual Acuity (UCDVA) Results
Group 1 - Femtosecond Laser Only
100%
n = 55 eyes
87%
80%
76%
60%
44%
40%
18%
20%
13%
2%
0%
≤ 20/15
Logmar Equivalent
≤ 20/20
≤ 20/25
≤ 20/30
≤ 20/40
> 20/40
Mean
Standard Deviation
Min
Max
0.18
0.21
-0.12
1
Uncorrected Distance Visual Acuity (UCDVA) Results
Group 1 - Femtosecond Laser Only Eyes Targeted for Distance
100%
90%
n = 49 eyes
82%
80%
60%
49%
40%
20%
20%
10%
2%
0%
≤ 20/15
Logmar Equivalent
≤ 20/20
≤ 20/25
≤ 20/30
≤ 20/40
> 20/40
Mean
Standard Deviation
Min
Max
0.17
0.17
-0.12
1
*Eyes targeted for distance only
Mean Absolute Value Prediction Error (MAVPE) Results
Group 1 – Femtosecond Laser Only
100%
89%
n = 55 eyes
93%
80%
69%
60%
40%
29%
20%
7%
0%
≤ 0.25
≤ 0.50
≤ 0.75
≤ 1.00
> 1.00
Mean
Standard Deviation
Min
Max
0.42 D
0.31 D
0.01 D
1.34 D
Uncorrected Distance Visual Acuity (UCDVA) Results
Group 2 - Femtosecond Laser and Intraoperative Aberrometry
100%
94%
n = 66 eyes
83%
80%
67%
60%
40%
33%
20%
6%
2%
0%
≤ 20/15
Logmar Equivalent
≤ 20/20
≤ 20/25
≤ 20/30
≤ 20/40
> 20/40
Mean
Standard Deviation
Min
Max
0.12
0.14
-0.12
0.54
Uncorrected Distance Visual Acuity (UCDVA) Results
Group 2 - Femtosecond Laser and Intraoperative Aberrometry
100%
100%
92%
n = 60 eyes
80%
73%
60%
37%
40%
20%
2%
0%
0%
≤ 20/15
Logmar Equivalent
≤ 20/20
≤ 20/25
≤ 20/30
≤ 20/40
> 20/40
Mean
Standard Deviation
Min
Max
0.09
0.09
-0.12
0.30
*Eyes targeted for distance only
Mean Absolute Value Prediction Error (MAVPE) Results
Group 2 – Femtosecond Laser and Intraoperative Aberrometry
100%
100%
94%
n = 66 eyes
80%
80%
60%
52%
40%
20%
0%
≤ 0.25
≤ 0.50
≤ 0.75
≤ 1.00
Mean
Standard Deviation
Min
Max
0.31 D
0.24 D
0.01 D
0.97 D
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
VerifEye
Mean Absolute Value Prediction Error (MAVPE) Results
Group 2 – Femtosecond Laser and ORA with VerifEye
n=26 eyes
Mean
Standard Deviation
Min
Max
0.30 D
0.21 D
0.01 D
0.85 D
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)
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