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Is Femtosecond Laser A Surgery Of Choice For Ophthalmic Surgeons?

Is Femtosecond Laser A Surgery Of Choice For Ophthalmic Surgeons?

October 9, 2019

With femtosecond laser surgery, the result is more accurate, reproducible and more importantly predictable. The advanced automation in such surgery has significantly reduced the risk and thus more surgeons are opting for femtosecond laser surgery. The results should be 100% safe for any technology to be used on a large scale. It should be faster, improves efficiency and should be safer than any of the previous versions for surgery. In such a scenario, the doctors would be more rapidly adapted towards technology.

Many technologies have evolved after femtosecond laser surgery but because of the comprehensive advantages provided by this technology, most of the doctors still rely on this surgical procedure. With more advanced versions in FLACS ( Femtosecond laser assisted Cataract Surgery ) its dominance may continue in the arena of ophthalmic surgeons. Many surgeons believe that such advanced surgery should only be used in cases when it is required. In many patients, the conventional procedure may provide similar results. However, the doctor should also discuss the same to patients before opting for any surgical procedure. According to some leading doctors, the technology should not be compelling rather should be used in complex cases and in the cases where its need is inevitable.

The procedure of femtosecond laser comprises of four main steps: Incision, limbal relaxing incisions, capsulotomy creation, and lens softening. A capsulotomy is one of the important steps in the femtosecond laser procedure that adds value to the overall vision. The leading surgeons perform maximum procures through femtosecond laser. Comprehensive details about ocular health are provided to the surgeon which helps in understanding the eye of the patient with minute details. Detailed eye examination also includes the biometric information of the eyes. According to some surgeons, all the steps of the femtosecond laser are quite important depending upon the patient’s ocular health.

In some patients, phacolysis is critical while for others a precision in capsulotomy is of great importance. In the toric IOLs, the critical step is capsule overlap. Place of corneal incisions in diffractive IOLs is important in determining the range of visual function along with the level of astigmatism.  In some patients, after evaluating the ocular health, the surgeon realises that the femtosecond laser may not be appropriate and the surgeons may opt for various other methods of surgery in these patients.

The efficiency of performing a femtosecond laser is increased when the expert surgeon is assisted by the partner in femtosecond laser cases. When the doctor in the operation theatre is performing the cataract surgery, the partner, who is trained in femtosecond laser, performs this procedure thereby improving the overall efficiency. Such a femtosecond laser is kept, by most doctors, in a preoperative room which is situated near to the operation theatre. The partner performing femtosecond laser is present in the pre-operative room.

The main and expert surgeon performs the advanced technology IOLs while these assistants perform astigmatism correction and monofocals. It is to be noted that the timing between the femtosecond laser and advanced IOLs should be coordinated. It is essential because a delay after the femtosecond laser reduces the size of the pupil. Thus, as soon as the patient has undergone a femtosecond laser, he must be transferred to the operation theater. To improve the pupil reaction, the surgeons, nowadays are performing capsulotomy with the cylinder inside.

With advanced technology, the femtosecond laser has reduced in size and it may now be possible to have them fitted in the operation theatre itself and no separate room is required. Further, now these apparatuses can be fitted in the phaco machines along with the microscope and there are high chances that the partners performing the femtosecond laser may not be required. Various methods are used for capsulotomy in different patients. Capsular overlap of higher degrees can be obtained through these methods. These methods include the Purkinje method of centering the capsulotomy and the Zepto method along with the Purkinje method. Optical Coherence Tomography guidance along with the femtosecond laser will increase the efficacy and more and more surgeons will use this combined technique in the future.

In the past few years, the docking system has been improved to have a more perfect fit on the corneal surface. Almost all the patients are eligible for undergoing femtosecond laser because of the incorporation of the advanced systems in the whole procedure. Further, this procedure is applied in such a manner that if one part is not applicable in some patients, the surgeon may process with other steps. For instance, if capsulotomy is not possible due to small pupil, at least segmentation is done to treat astigmatism. It is also to be noted that the patient visits the surgeon based on the technology used, rather they trust the surgeon for improving their vision. The surgeons also guide the patient that they will use the combination of the best technology available for improving the quality of vision.

Femtosecond laser-assisted cataract surgery (FLACS) procedure has seen stagnant growth during these years however many of the leading eye surgeons are using the advanced version of this highly effective surgical procedure. The reason for this may be to resist using advanced femtosecond laser surgery. Many surgeons are happy with their methods of performing the surgery as they might be uncomfortable in performing surgery by using laser technology. As this resistance for suing laser technology shatters, there would be a significant increase in using femtosecond laser surgery. Further, the next generation of ophthalmic surgeons are also trained with these advanced femtosecond laser surgeries and thus the future will see increases used of this surgical procedure. The precision of FLACS is excellent and has undergone various developmental processes including better accuracy, high efficiency, and simple docking. It may be considered as the future of cataract surgery.

Some surgeons believe that femtosecond laser surgery should not be the only option for cataract surgery rather the surgeons should analyze all the options available for performing such surgeries.


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