The annual meeting for the American Society of Cataract and Refractive Surgery brought together great clinicians, surgeons, and researchers to share new concepts and technologies. While one article cannot do justice to all the information acquired, this article will share some of the most exciting topics discussed this year.
Femtosecond laser Cataract Surgery.
Perhaps the most widely discussed topic both inside and outside the convention center, femtosecond laser technology has now become available for cataract surgeons in the US. Providing more precise capsulorhexis and nucleus fragmentation, it is touted to improve surgical outcomes not only in safety but also visual outcomes. Additionally, these lasers can be programmed to perform limbal relaxing incisions to precise depths and at exact lengths. Currently, Optimedica, Alcon, and LensAR all have lasers but no direct comparisons have yet been made. Videos displayed by surgeons such as Dr. Robert Cionni demonstrated that this technology is ready for prime time and may already provide noticeable improvements in cataract surgery outcomes. Dr. Zoltan Nagy also presented data proving better outcomes with femtosecond rather than manual capsulotomoy, more specifically smaller intraocular vertical tilt and coma, higher strehl ratio, and improved modulation transfer functions (MTF).
Advancing LASIK surgery.
In a paper presented by Eric Donnenfeld, a contralateral eye study was performed comparing 30 degree side cut flaps and 140 degree reverse side cut flaps. Patients were evaluated 180 days postoperatively for corneal sensation, conjunctival and corneal staining, tear film breakup times, and schirmer score. In all categories the 140 degree reverse side cut flaps fared better, indicating a change LASIK surgeons can make today to improve postoperative outcomes.
Collagen crosslinking combined with PRK.
In a study by Dr. Simon Holland, contact lens intolerant keratoconus patients underwent simultaneous topography guided PRK and collagen crosslinking. Improved uncorrected visual acuity was obtained in 70% of patients, but enrollment was limited because or residual stromal thickness requirements. That said, this paper provides us promising information for our early diagnosed keratoconus patients.
New insight into negative dysphotopsias.
Characterized by a sensation of a temporal shadow in the vision, these can be mildly frustrating or completely debilitating to patients. Unfortunately, our understanding of the etiology and treatment of these is limited. In a paper presented by Dr. Samuel Masket, ray tracing simulations support that these visual symptoms are related to interactions between pupil size, capsulorrhexis size, and optical diffusiveness of the capsular bag.
New techniques for glaucoma surgery.
In the film festival, top awards went to Dr. Hoffman for his video "Minimally Invasive External Mini-Glaucoma Shunt Implantation Without Conjunctival Dissection." As described in the title, scleral dissection is made from a 350 micron corneoscleral limbal incision. A crescent blade that is used to dissect posteriorly is then used to enter the subconjuntival space. The cornea and scleral pocket are held apart while the shunt is implanted, and the limal incision is then closed with one 10-0 horizontal nylon suture. In this fashion, conjunctival dissection as well as hemocautery is avoided. In addition to lessening surgical time, this technique likely improves outcomes by minimizing scarring and improving patient postoperative discomfort.
Ultimately, the 2011 ASCRS meeting provided helpful information to all attendees whether they were cataract, cornea, refractive, or glaucoma specialists. With the information presented in this paper, along with the overwhelming amount of terrific presentations held at the meeting, we can provide even greater care for our patients now.