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This month’s cover story looks at how new lenses designed to take advantage of the precise capsulotomies made possible by femtosecond lasers hold the potential to solve many refractive issues with intraocular lenses (IOLs). They may do everything from enhancing the predictability of lens position to reducing higher order aberrations and eliminating lens dislocation and tilt, edge dysphotopsias and PCO.

In our cover story we look at the various lenses now on the market with grooves designed to snap into a precisely sized capsulotomy as well as devices and pharmaceuticals that might be used with them to enhance their inherent stability, such as capsule tension rings and antifibrotics that modulate healing responses.

So where do we go from here? Early data from the ongoing ESCRS Femtosecond Laser-Assisted Cataract Surgery Study show that nearly 98 per cent of more than 2,000 FLACS procedures reported through August 6, 2014 involved laser-cut capsulotomy, with laser nuclear fragmentation second at 90 per cent. By comparison, only one in three FLACS procedures involved laser-cut corneal incisions and one in five astigmatism correcting incisions.

As one of the doctors who contributed to the cover story, I would agree that laser cut capsulotomy has exciting possibilities. But I would also urge caution based on a 2013 retrospective study of manual capsulorhexes involving 635 patients which I carried out. My study compared cases with “optimal” rhexes of 4.5mm to 5.5mm and 360-degree optic overlap with eccentric and smaller rhexes and found no significant difference in lens tilt or anterior chamber depth change, and a mean difference in centration of just 0.08mm in the eccentric group, three months after surgery. This would not result in any benefit for patients.

My colleagues Dr Julian Stevens, Dr Jack Holladay, Dr Ludger Hanneken and Dr Samuel Masket also make excellent contributions to the discussion on this subject in our cover story and I would encourage you to read and digest
their comments.

But I would also urge EuroTimes readers to look at the wider question of the limits to what we as surgeons and doctors can achieve in ophthalmology using the new technologies and devices that are coming on the market.


Duty of care

We must not forget that our first duty of care is to our patients. We must work closely with industry to make sure that new devices and technologies will result in better outcomes. We must also remember that as doctors we must follow our own instincts and decide what works best for us as individual doctors.

In other words, we all have different skill sets and while an individual laser, for example, may work very well for one doctor, it might not work as well for his colleague in another clinic or hospital. My colleague Dr Peter Barry addressed this subject recently in EuroTimes (Vol 19, Issue 4, P44, April 2014) when he pointed out that quality can only be achieved by listening to patient feedback.

As chairman of the ESCRS Young Ophthalmologists Committee, I have repeated this message to doctors in training but it also holds true for those colleagues who have years of experience and who are well established in their practices.

In conclusion, there is much to consider and to debate and I hope you enjoy the continuing discussion in this issue and future issues of EuroTimes.

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