When femtosecond laser-assisted cataract surgery, or FLACS, came to the United States earlier this decade, a host of new clinical and financial challenges were brought upon the premier refractive cataract surgeon. The philosophy of FLACS has changed over the last few years with improvements in software and additional features such as the Streamline process from Lensar for astigmatism management. Companies such as Lensar are thinking progressively so more can be accomplished with the femtosecond systems we currently use. Competition breeds advancements significantly. My experience has been with the Lensar exclusively, so I will share my story with FLACS technology and its enhanced use in my practice.
The future of FLACS is already here, with Lensar having its third software upgrade in 2 years with Streamline I, II and now III. Lensar initiated its iris registration capability with the Cassini corneal shape analyzer, enabling the wireless transfer of data from preoperative corneal measurements to the actual Lensar femtosecond system. Since Cassini, Streamline III now allows for other topographers such as the Pentacam HR/AXL (Oculus), OPD III (Marco/Nidek) and Aladdin (Topcon) to be integrated as well. Iris registration eliminates the need for marking the eye for cyclorotation before laser treatment and automatically modifies the treatment plan to account for cyclorotation by comparing preoperative topography reference images from the devices mentioned above with the image taken by the Lensar laser while the eye is docked in the OR live. The wireless transfer of data to the Lensar reduces time-consuming steps that reduce efficiency and prolong procedure times. Automatic transfer of data also eliminates the potential for errors in reading and writing, errors that can compromise outcomes in the end. During scanning with Lensar while the eye is docked, automatic cataract density imaging and automatic preprogrammed fragmentation patterns are selected to increase efficiency in the eye.
My top five reasons to perform FLACS
5. Many platforms are small and portable with no bed attachments, such as the Lensar, LenSx (Alcon) and Ziemer, which allows for OR use to maximize efficiency. When I converted to FLACS, my per-hour one-room procedure time with Lensar only dropped from 4.2 cases per hour to 3.8 cases per hour, which was not clinically significant.
- Click here to read the full publication exclusive, The Premium Channel, published in Ocular Surgery News U.S. Edition, August 10, 2017.