by Joseph San Laureano | Jul 23, 2013 | blog
At the recent AUSCR meeting in Ayer’s rock, I meet and spoke with Dr Warren Hill who is considered a world expert in cataract surgery. We spoke in some detail about cataract surgery planning for patients with significant astigmatism requiring the implantation of a toric lens. He convinced me to use the Zeiss Atlas 9000 as he suggested that axis determination was far more accurate than our current method. Specifically, he advocated using the Atlas to determine the true cylinder axis and the setting this information on our manual, Javal Schiotz keratometer. Thus the keratometer would be set at the axis indicated by the Atlas and a K1 reading obtained then re-measuring the K2 at 90 degrees to that. This would give me the cylinder power which would then be plugged in to our lens calculation formula as it only requires the magnitude. The axis would then be used in toric aligment intraoperatively.
This meeting with Warren has proved expensive as my practice has added an Atlas to our armamentarium.
by Joseph San Laureano | Jul 5, 2013 | blog
Today’s meeting was wholly devoted to femtosecond laser cataract surgery. The meeting became quite heated with many people, passionately expressing their views both for and against it. My impression was the the naysayers where mainly arguing about the cost. Brendan Vote from Tasmania was in my mind the most interesting speaker. He gave two presentations, one showing that the surgery at present is not economically viable and a second presentation where he presented data looking at the electron microscopy of the laser created capsulorhexis of both the femto and the non femto cases.
Cost
There is no argument that at present this type of surgery is not cost effective. He said and I quote “Multivariate sensitivity analyses revealed that LCS would need to significantly improve visual outcomes and complication rates over PCS, along with a significant reduction in cost to patient, to improve cost effectiveness”. He showed data that at present cost effectiveness in $/QALY was AU$92,862. It would need to be less than $50,000 to be cost effective. The total QALY gain for LCS over PCS was 0.06 units. He also presented a Numbers Needed to Treat analysis which looks at reducing just one case of corneal decompensation which demonstrated that it is not cost effective. Thus the conclusion was that it needs to get a whole lot cheaper.
Capsulorhexis
Dr Vote also presented data about the very rough appearance of the laser cut edge when viewed under an electron microscope and compared it to the relatively smooth appearance of manually created ones. The implication here is that this may translate to an increase, anterior capsular tear rate. This however has not been shown clinically so is merely supposition.
Clinical videos
A number of femto surgeons presented video of their femto surgeries, giving us their clinical pearls.
Conclusions
There where really not conclusions with just as many surgeons arguing for as against with really no one changing their positions
My Impression
I have also not changed my position and like many others argue that THE only argument against it is purely cost. There is no doubt that it is more advanced and safer surgery and will with time dominate cataract surgery around the world. Prices will fall and the discussions will come to an end. I also believe, as do others, that the technology needs to change and become more integral with our current equipment, to eliminate the moving of patients from one room to another. It needs to be part of the phaco equipment or part of the microscope
by Joseph San Laureano | Jul 4, 2013 | blog
Well today was the first day of the AUSCRS conference in Ayer’s rock. Disappointingly it is a small turnout, about 1/4 of last year’s. It is however made up for by the presence of Warren Hill, who I got to speak to quite a bit and pick his brain, and also Boris Malyugin of the Malyugin ring fame. The topics discussed where much the same as in previous years although each year the thinking is slightly different as people gather more experience with each topic. There was a very interesting segment in which a number of surgeons presented video of their surgery with commentary about why they did things the way that they did. There was also an interesting segment presented by Boris Malyugin on difficult surgery and how to deal with it.
Presbyopia
Sadly this subject has not changed much and in fact it looks like there is not much new coming up here in the foreseeable future. The discussion really boiled down to three main topics; monovision, multifocal implants and corneal approaches using laser techniques. INTRACOR got bad rap and looks like a likely dead duck and other laser approaches, to me seemed no different to previous years. I wold say that this approach did not really excite me or convince me to try them. Similarly, the KAMRA corneal inlay did not get a good showing and it looks like enthusiasm for it is rapidly waining. Multifocal intraocular lenses as usual had their proponents but again nothing really new here. Boris Malyugin did describe an experimental new lens without any diffraction pattern on it which instead worked on having polymers of varying refractive indices which might see the light of day (no pun intended). It however still works by dividing the available light into near and distance so it will still likely reduce contrast sensitivity. Graham Barrett again presented his argument for mono vision which I personally agree is still the best option.
Femto cataract surgery
This subject was only briefly discussed and I suspect will feature more heavily tomorrow
IOL calculations for cataract surgery
Warren Hill gave an excellent presentation on this subject which left me with the impression that there was new stuff coming in the near future. This subject is very important as the bane of the cataract surgeon’s life is the refractive surprise.
Looking forward to more good stuff tomorrow
by Joseph San Laureano | Jul 2, 2013 | blog
I am hosting a tour of the Catalys Femtosecond laser cataract surgery facilities at the VPSC in East Melbourne for optometrists.
During this evening I will present a no nonsense, evidence based look at the current literature in an attempt to clarify why I believe that this is the way of the future. After that, I will conduct a tour of the facilities which will include a live demonstration of the laser in action.
Drinks and tasty finger food will be provided.
If you are interested in attending, please send an email on our “contact us” page of this site.
by Joseph San Laureano | Jul 1, 2013 | blog
I don’t usually post non ophthalmology material on my site but I thought I would make an exception this time. I am at the 2013 cataract and refractive conference (AUSCRS) in Ayer’s Rock. I arrived a few days early so that I can indulge my passion of landscape photography. Like everyone I took a sunset image of the rock it self. I went with an old friend of mine and his 14 year old son who hopefully will have been inspired to take up photography. Today I am of to The Olga’s to see if can get something of interest there. Conference starts on wednesday
