Femtosecond laser technology for cataract surgery has improved dramatically since these devices were first approved in 2010.
The four platforms that are currently approved for use in the United States are the LenSx laser from Alcon, CATALYS Precision Laser System from OptiMedica/AMO, LensAR Laser System from LensAR, and VICTUS Femtosecond Laser Platform from B+L. All of these lasers have clearance for all corneal and lens incisions. The FEMTO LDV Z8 from Ziemer has CE Mark but is not yet FDA approved.
The recent advances in these devices, which are summarized below, have improved the usability of the lasers while decreasing treatment times.
LenSx Laser
The most important upgrades to this femtosecond laser are modifications to the patient interface and computer software. The SoftFit interface contains a disposable hydrogel contact lens placed inside the applanating cone to allow for a gentler docking to the patient’s eye with less IOP elevation and more patient comfort. It also allows for more consistent capsulotomies because less compression of the cornea reduces posterior corneal folds and thus the risk of an incomplete capsulotomy from attenuation of the laser beam. The new software automatically centers the treatment on the pupil with a touch of the joystick button, and there is a new lens fragmentation option to create a grid pattern. The laser is also part of Alcon’s integrated Cataract Refractive Suite, a multicomponent system that allows for exchange of patient information between devices. This Suite also includes the VERION Image Guided System, LuxOR LX3 surgical microscope, and CENTURION Vision System phaco machine. Surgical planning and positioning data and a digital image of the ocular landmarks captured with the VERION are automatically transferred to the LenSx Laser to improve accuracy of incision placement. Alcon acquired WaveTec and is incorporating the ORA intraoperative guidance system into the Cataract Refractive Suite. The LenSx Laser is also available as a mobile unit (MoFe) through Sightpath Medical.
CATALYS Precision Laser System
The FDA recently granted 510(k) clearance to AMO for an improved operating system and smaller diameter patient interface for the CATALYS system. This new generation cataract Operating System 3 (cOS3) consists of more than 50 updates to increase the efficiency and speed of the procedure. The most noticeable difference is the redesigned and simplified template-based interface, which is more intuitive and allows the user the ability to better customize the planning and treatment. Surgeons are now able to view high-resolution streaming OCT images during the procedure. As a result of these improvements, treatment times have decreased by a third. A future advance will be intraoperative measurement of the steep corneal meridian to more accurately treat astigmatism. The new LOI (Liquid Optics Interface 12) has been redesigned with an inner diameter measuring 12.0 mm and an outer diameter measuring 19.0 mm. This is the smallest interface available and more easily docks patients with small eyelid apertures. The system now automatically centers the docking and minimizes all forces from the eye.
LensAR Laser System
This device was originally developed as a method for treating presbyopia, and LensAR is continuing to investigate lenticular softening to treat this universal condition. The company is also establishing an integrated system along with devices from I-Optics and TrueVision 3D to allow information to be transferred seamlessly between the Cassini Corneal Topographer, LensAR laser system, and TrueGuide system. In addition, TrueVision 3D and Leica have developed a partnership to combine computer guidance into the ophthalmic surgical microscope. The LensAR laser also is available as a mobile unit from Precision Eye Services.
VICTUS Femtosecond Laser Platform
The VICTUS has received FDA clearance for lens fragmentation, so this device can now perform all incisions for cataract surgery as well as corneal incisions for LASIK, penetrating keratoplasty and Intacs. The patient interface has been enlarged internally to capture a wider field of imaging. A software upgrade improves the user interface for easier planning and faster treatments. The imaging system also has been updated with advanced swept-source OCT to allow real time monitoring of the procedure with high resolution scans. Another advance is a joint venture with Cirle, which will enable an image-guided navigation system with use of a surgical microscope.
FEMTO LDV Z8
This device received CE approval last year for clear corneal, arcuate, capsulotomy, and lens fragmentation incisions. It is a mobile device that utilizes a liquid patient interface and high-definition 3D Fourier-domain OCT.
Femtosecond laser assisted cataract surgery continues to be an exciting topic in ophthalmology. The technology in this arena has advanced considerably since the first generation devices were approved. In the future, we should expect to see continued progress with respect to faster and more accurate treatments, especially with the recent partnerships among manufacturers to combine multiple planning and diagnostic devices to form integrated systems.