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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 on theme: "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."— Presentation transcript:

1 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

2 WWW.AAO.ORG 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

3 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

4 Financial Disclosures Alcon - Consultant and Lecture Fees

5 Purpose To determine the impact of intraoperative aberrometry on uncorrected visual acuity and predictability (MAVPE) in Femtosecond laser cataract surgery

6 Background Outcomes analysis in the literature  Narvaez / Stulting JCRS Dec. 2006  643 eyes 46 % within 0.50 D of formula predicted target MAVPE: 0.52 D ± 0.44 D  Gale et al, Eye Aug. 2007  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 2012 17,506 case (performed between 2008-2010) 55% achieved refractive target (0.00 D sphere,<1.00 D of astigmatism MAVPE: 0.50 D ± 0.34 D

7 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)

8 Baseline Characteristics Group 1 – Femtosecond Laser Only AgePreoperative Flat K Preoperative Steep K Preop Keratometric Cylinder Axial Length White to White Mean6942.9943.860.8724.3112.11 Min3639.7841.27021.7711.08 Max8246.6247.46.3429.6913.1 Standard Deviation 91.471.500.951.600.49 55 eyes of 55 patients 23 of 55 (42%) male 32 of 55 (58%) female SN60WFSN6AD1SN6ATx 30 (55%)17 (31 %)8 (14 %)

9 Baseline Characteristics Group 2 – Femtosecond Laser and Intraoperative Aberrometry AgePreoperative Flat K Preoperative Steep K Preop Keratometric Cylinder Axial Length White to White Mean6643.3744.280.9023.5912.20 Min2239.5639.95021.3111.44 Max8446.6847.354.5926.0713.24 Standard Deviation 111.451.630.700.950.44 66 eyes of 50 patients 22 of 50 (44%) male 38 of 50 (56%) female SN60WFSN6AD1SN6ATx 26 (40%)32 (48%)8 (12%)

10 Uncorrected Distance Visual Acuity (UCDVA) Results Group 1 - Femtosecond Laser Only MeanStandard DeviationMinMax Logmar Equivalent0.180.21-0.121 n = 55 eyes

11 Uncorrected Distance Visual Acuity (UCDVA) Results Group 1 - Femtosecond Laser Only Eyes Targeted for Distance MeanStandard DeviationMinMax Logmar Equivalent0.17 -0.121 n = 49 eyes *Eyes targeted for distance only

12 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

13 Uncorrected Distance Visual Acuity (UCDVA) Results Group 2 - Femtosecond Laser and Intraoperative Aberrometry MeanStandard DeviationMinMax Logmar Equivalent0.120.14-0.120.54 n = 66 eyes

14 Uncorrected Distance Visual Acuity (UCDVA) Results Group 2 - Femtosecond Laser and Intraoperative Aberrometry MeanStandard DeviationMinMax Logmar Equivalent0.09 -0.120.30 n = 60 eyes *Eyes targeted for distance only

15 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

16 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

17 VerifEye

18 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

19 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)

20 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

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