by Joseph San Laureano | Jun 26, 2013 | blog
It has been just over two years since I started cataract surgery in Kyneton and we are now coming up to the 200th patient.
The path to Kyneton was neither easy nor quick. It took me nearly two years to make it happen. I had to provide all the surgical instruments, the operating microscope and the phaco machine out of my own pocket.
At present what this means is that locals can have their cataract surgery without travelling to Melbourne or Bendigo. Of course, anyone wanting laser cataract surgery still has to come to Melbourne as Kyneton hospital is not about to buy an almost 1 million dollar machine for this.
In the end we were supported by Bausch & Lomb who kindly provided the phaco machine.
The practice at Kyneton was set up specifically to provide a surgical service to patients requiring cataract surgery and also to perform assessment for patients looking for laser refractive surgery. My arrival in Kyneton was timely as the previous ophthalmologist, retired about the same time. This has meant that in addition to surgical patients, I have inherited the local glaucoma population. This has worked out OK except for the fact that I do not have the equipment to fully asses glaucoma patients. Instead, I have been co-managing with the local optometrists which has worked quite well.
I am hopping that the Kyneton hospital sees the value of this service and allows us to increase our surgical numbers.
by Joseph San Laureano | Jun 19, 2013 | blog
Our website has moved to a new home on a new server. The migration has not bee smooth with many problems along the way. That is why I have not recently been able to post. Hopefully theses problems are behind us.
In early July I will be attending the Australian Cataract and Refractive Surgery conference (AUSCRS) which is in Ayers Rock this year. It promises to be a very exiting conference this year as there a number of big names in refractive surgery attending. Not least of which is Dr Warren Hill from the US who is considered a guru. His main topic of interest, and the reason why I look forward to hearing him speak, is lens calculations in cataract and refractive surgery and the never ending problem of how to optimise refractive outcomes.I have no doubt that the hot topic will again be femtosecond laser cataract surgery as it is still what everyone is arguing about and which ties in nicely with the topics that Dr Hill will discuss. I will be providing regular Twitter updates on topics of interest
by Joseph San Laureano | Jun 2, 2013 | blog
I this article I present my own results and discuss where I think femto cataract surgery is going.
In my last article I looked at what published literature existed to try to bring some evidence into this discussion. It seemed to me that there is increasing evidence that with femtosecond cataract surgery there is mounting evidence for its superiority.
Last week I chaired a discussion at The Victoria Parade Surgical Centre (VPSC) in East Melbourne, along with a couple of other ophthalmologists who had also commenced performing it and with the current Royal Victorian Eye and Ear registrars. The purpose of the meeting was two fold. Firstly to introduce the registrars to the technology and secondly to have a frank discussion about the technology. The evening ended with a demonstration of the machine on a dummy eye.
Out of all the ophthalmologists who are current VPSC users, I am the most experienced with 50 cases. The nearest other surgeon had 12 and the third had 4. I presented my own data at that meeting.
My Results of Femtosecond Cataract surgery
To date 50 cases.
Follow up refractions 35 the remainder not yet reviewed.
Of these 35, the majority are within 0.1 D SE !
There are 5 outliers, the largest being 0.75D. This is a female whose target refraction was -2.5 (Her request) but ended up -3.25. It’s worth pointing out that this patient had a very small 21mm eye and that the lens calculations were performed by the lens manufacturers rather than ourselves.
The second outlier is 0.4D with the other 3 within 0.25D
Now, I have not compared these results with my non femto patients of the same time period, but I am sure that I am will not find such tight results when I do look at them.
Complications
To date I have had no complications related to the femto procedure itself.
I have had one case of CMO which most likely is unrelated and one case of an anterior capsular tear which still permitted implantation of the lens in the bag and was in a patient who poorly dilated and in whom I performed a small capsulorhexis.
I note that Brendan Vote from tasmania has reported a number of anterior capsular tears and has presented some histological findings that he purports to show that femto rhexis may not be as strong as non femto ones. I await more information as it is looked at it.
My thoughts and conclusions
I was asked at the registrar presentation wether I would choose femto cataract surgery for myself or for my own mother.
My answer is an unequivocal yes. My view is that I cannot see a single argument other than cost, not to have it.
If this technology does absolutely nothing more than produce neater wounds, a neater capsulorhexis (every time) with perfect overlap of the intraocular lens and broke up the lens so there is less work and phaco energy in removing it, then there can be no argument.
There is no doubt that cost will come down. In fact Catalys have already announced a 20% price reduction.
I also have no doubt that will not be seeing this in rural centres anytime soon, as no rural centre can afford the technology. I believe however that it will steadily replace phaco and with time it will probably be made smaller and integrated with the microscope or the phaco machine itself.
I will periodically revisit this subject as I collect more information
by Joseph San Laureano | Jun 2, 2013 | blog
Joseph San Laureano and Esther Briganti at the 2013 SRC
Thank you everyone who came to visit us at our booth at the 2013 Southern Regional Congress at the Melbourne convention centre.
Joseph San Laureano, Esther Briganti, Anh Le and Eylem Osman where all there talking to our regular referrers and to some hopefully new ones.
We sponsored an afternoon tea and a lunch.
