0 Femtosecond-Laser Assisted Cataract Surgery: Is it living up to the hype? 117 th Annual Meeting of the American Academy of Ophthalmology Press Briefing.

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Presentation transcript:

0 Femtosecond-Laser Assisted Cataract Surgery: Is it living up to the hype? 117 th Annual Meeting of the American Academy of Ophthalmology Press Briefing Nov. 18, 2013

AMERICAN ACADEMY OF OPHTHALMOLOGY 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

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  643 eyes 46 % within 0.50 D of formula predicted target MAVPE: 0.52 D ± 0.44 D  Gale et al, Eye Aug  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 ,506 case (performed between ) 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 AgePreoperative Flat K Preoperative Steep K Preop Keratometric Cylinder Axial Length White to White Mean Min Max Standard Deviation eyes of 55 patients 23 of 55 (42%) male 32 of 55 (58%) female SN60WFSN6AD1SN6ATx 30 (55%)17 (31 %)8 (14 %)

Baseline Characteristics Group 2 – Femtosecond Laser and Intraoperative Aberrometry AgePreoperative Flat K Preoperative Steep K Preop Keratometric Cylinder Axial Length White to White Mean Min Max Standard Deviation eyes of 50 patients 22 of 50 (44%) male 38 of 50 (56%) female SN60WFSN6AD1SN6ATx 26 (40%)32 (48%)8 (12%)

Uncorrected Distance Visual Acuity (UCDVA) Results Group 1 - Femtosecond Laser Only MeanStandard DeviationMinMax Logmar Equivalent n = 55 eyes

Uncorrected Distance Visual Acuity (UCDVA) Results Group 1 - Femtosecond Laser Only Eyes Targeted for Distance MeanStandard DeviationMinMax Logmar Equivalent n = 49 eyes *Eyes targeted for distance only

Mean Absolute Value Prediction Error (MAVPE) Results Group 1 – Femtosecond Laser Only MeanStandard DeviationMinMax 0.42 D0.31 D0.01 D1.34 D n = 55 eyes

Uncorrected Distance Visual Acuity (UCDVA) Results Group 2 - Femtosecond Laser and Intraoperative Aberrometry MeanStandard DeviationMinMax Logmar Equivalent n = 66 eyes

Uncorrected Distance Visual Acuity (UCDVA) Results Group 2 - Femtosecond Laser and Intraoperative Aberrometry MeanStandard DeviationMinMax Logmar Equivalent n = 60 eyes *Eyes targeted for distance only

Mean Absolute Value Prediction Error (MAVPE) Results Group 2 – Femtosecond Laser and Intraoperative Aberrometry MeanStandard DeviationMinMax 0.31 D0.24 D0.01 D0.97 D n = 66 eyes

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 MeanStandard DeviationMinMax 0.30 D0.21 D0.01 D0.85 D n=26 eyes

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