Femtosecond-Laser Assisted
Cataract Surgery:
Is it living up to the hype?
117th Annual Meeting of the American
Academy of Ophthalmology
Press Briefing
Nov. 18, 2013
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
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
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. 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
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
• 55 eyes of 55 patients
• 23 of 55 (42%) male
• 32 of 55 (58%) female
Age
Preoperative
Flat K
Preoperative
Steep K
Preop
Keratometric
Cylinder
Axial
Length
White
to
White
Mean
69
42.99
43.86
0.87
24.31
12.11
Min
36
39.78
41.27
0
21.77
11.08
Max
82
46.62
47.4
6.34
29.69
13.1
Standard
Deviation
9
1.47
1.50
0.95
1.60
0.49
SN60WF
SN6AD1
SN6ATx
30 (55%)
17 (31 %)
8 (14 %)
Baseline Characteristics
Group 2 – Femtosecond Laser and Intraoperative Aberrometry
• 66 eyes of 50 patients
•22 of 50 (44%) male
•38 of 50 (56%) female
Age
Preoperative
Flat K
Preoperative
Steep K
Preop
Keratometric
Cylinder
Axial
Length
White
to
White
Mean
66
43.37
44.28
0.90
23.59
12.20
Min
22
39.56
39.95
0
21.31
11.44
Max
84
46.68
47.35
4.59
26.07
13.24
Standard
Deviation
11
1.45
1.63
0.70
0.95
0.44
SN60WF
SN6AD1
SN6ATx
26 (40%)
32 (48%)
8 (12%)
Uncorrected Distance Visual Acuity (UCDVA) Results
Group 1 - Femtosecond Laser Only
100%
n = 55 eyes
87%
80%
76%
60%
44%
40%
18%
20%
13%
2%
0%
≤ 20/15
Logmar Equivalent
≤ 20/20
≤ 20/25
≤ 20/30
≤ 20/40
> 20/40
Mean
Standard Deviation
Min
Max
0.18
0.21
-0.12
1
Uncorrected Distance Visual Acuity (UCDVA) Results
Group 1 - Femtosecond Laser Only Eyes Targeted for Distance
100%
90%
n = 49 eyes
82%
80%
60%
49%
40%
20%
20%
10%
2%
0%
≤ 20/15
Logmar Equivalent
≤ 20/20
≤ 20/25
≤ 20/30
≤ 20/40
> 20/40
Mean
Standard Deviation
Min
Max
0.17
0.17
-0.12
1
*Eyes targeted for distance only
Mean Absolute Value Prediction Error (MAVPE) Results
Group 1 – Femtosecond Laser Only
100%
89%
n = 55 eyes
93%
80%
69%
60%
40%
29%
20%
7%
0%
≤ 0.25
≤ 0.50
≤ 0.75
≤ 1.00
> 1.00
Mean
Standard Deviation
Min
Max
0.42 D
0.31 D
0.01 D
1.34 D
Uncorrected Distance Visual Acuity (UCDVA) Results
Group 2 - Femtosecond Laser and Intraoperative Aberrometry
100%
94%
n = 66 eyes
83%
80%
67%
60%
40%
33%
20%
6%
2%
0%
≤ 20/15
Logmar Equivalent
≤ 20/20
≤ 20/25
≤ 20/30
≤ 20/40
> 20/40
Mean
Standard Deviation
Min
Max
0.12
0.14
-0.12
0.54
Uncorrected Distance Visual Acuity (UCDVA) Results
Group 2 - Femtosecond Laser and Intraoperative Aberrometry
100%
100%
92%
n = 60 eyes
80%
73%
60%
37%
40%
20%
2%
0%
0%
≤ 20/15
Logmar Equivalent
≤ 20/20
≤ 20/25
≤ 20/30
≤ 20/40
> 20/40
Mean
Standard Deviation
Min
Max
0.09
0.09
-0.12
0.30
*Eyes targeted for distance only
Mean Absolute Value Prediction Error (MAVPE) Results
Group 2 – Femtosecond Laser and Intraoperative Aberrometry
100%
100%
94%
n = 66 eyes
80%
80%
60%
52%
40%
20%
0%
≤ 0.25
≤ 0.50
≤ 0.75
≤ 1.00
Mean
Standard Deviation
Min
Max
0.31 D
0.24 D
0.01 D
0.97 D
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
n=26 eyes
Mean
Standard Deviation
Min
Max
0.30 D
0.21 D
0.01 D
0.85 D
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