Trey Bishop, MD

Trey Bishop, MD

Bishop Eye Associates

Practice community
Hilton Head Island, SC

Hospital affiliation
Outpatient Surgery Center of Hilton Head, SC

Number of years in practice

Practice niche
Cataract surgery

Favorite hobby

What initially made you consider femtosecond laser technology for your practice? 

We felt the ability to perform precise and accurate incisions combined with the ability to pretreat the cloudy nucleus before ultrasound would help our surgical results. We are constantly pushing the limits of what our technology can do to better the patient’s experience, and femtosecond laser was a natural progression.

Why specifically did you choose the CATALYS® Precision Laser System (Abbott Medical Optics [AMO]), and when did you acquire the laser?

We chose the CATALYS® System for a number of reasons. First, the high-definition imaging allows an incredible surgical view. Second, the proprietary software analyzing the images and guiding the surgical decisions allows highly customizable treatments that, for example, allow us to achieve near perfect centration of the capsulorrhexis every time. Third, the intuitive user interface creates a friendly environment to fine tune the surgical plan as needed. Last, and just as important, the patient requires no sedation.

We acquired our CATALYS® System in December 2015. Interestingly, we transitioned from a different vendor’s femtosecond laser that we acquired 3 years earlier and had used to perform more than 2,000 procedures. Despite the cost, we made the transition to the CATALYS® System for the above-mentioned reasons.

What are the benefits of laser-assisted technology in a private practice?

Three major benefits are associated with the use of laser-assisted cataract surgery in a private practice setting. The first is results. Our patients expect outstanding results with gentle experience, and femtosecond technology allows us to deliver that on a daily basis. 

The second benefit is innovation. We are constantly striving to better our results and improve the patient experience. Femtosecond technology keeps us motivated and enthusiastic and helps us stay on the cutting edge to push the limits of our technology.

Last, laser-assisted technology helps with financial freedom. In the current practice environment, reimbursements are diminishing, and costs are increasing. In our practice we educate our staff members so they can provide the highest level of care to our patients. We strive to continuously update our technology.

What impact has the CATALYS® Precision Laser System had on your overall business model?

Our business model per se did not change. However, our confidence in the technology incrementally improved, resulting in a palpable enthusiasm and satisfaction, both from the patient and surgeon. The CATALYS® System is truly a premium experience on many levels, which naturally benefits the business model.

How many cataract surgeries must you perform with the CATALYS® Precision Laser System per year to make the investment financially viable for your practice?

Obviously, the quantity varies from practice to practice. We already had a high rate of implanting TECNIS® Multifocal IOLs (AMO) and toric IOLs. Therefore, financial profit to support the CATALYS® System had to come from one of two sources: increasing our premium IOL prices, performing CATALYS® System procedures for additional patients who are not receiving premium IOLs. We decided to minimally increase our prices to keep the technology accessible to as many patients as possible. We found our enthusiasm for the technology manifested in more patients choosing the CATALYS® System, and our results created greater patient and surgeon satisfaction. Hence, the financial investment was easily justified.

What benefits have you enjoyed as a result of implementing the CATALYS® Precision Laser System?

My favorite feature is the ability to centrate the continuous curvilinear capsulorrhexis, which is important when implanting a multifocal IOL. This feature is another check and balance to ensure the multifocal IOL is centered perfectly. The proprietary software allows the surgeon to center that capsulorrhexis on the anatomical center of the cataract itself.

As far as the efficiency of the laser, we can treat out past the capsulorrhexis. Using the imaging to maximize the nuclear treatment before ultrasound for those clinical scenarios is critically important.

Please provide some tips and techniques for using an INTEGRAL GUIDANCE system that automatically calculates ocular dimensions.*

First, the surgeon must capture excellent images, and that starts with the patient. Patient positioning as well as physical and mental comfort are critical. Reassuring and talking with the patient so that he or she is relaxed is important so that the surgeon can capture high-definition imaging. 

The surgeon should properly align the patient interface to the patient’s anatomy and then gently position the patient under the video imaging system. Selecting the proper patient interface size is also important to increase the ease and comfort of the patient during the procedure.

It is critical to confirm all the images before implementing the surgical plan. The user interface allows the surgeon to make necessary changes immediately before implementing the surgical plan. The surgeon can also re-scan if he or she is not happy with an image.

Last, the surgeon must pay attention. The interface is user-friendly, so it is easy to become lulled and complacent. With any technology, it is important to continue to pay attention to make sure that the patient is well-positioned and comfortable and that the treatment is going as planned until it is completed.

*AMO does not engage in the practice of medicine and any clinical information that may be contained in this excerpt is not a substitute for appropriate medical education and training or for the exercise of independent medical judgment. Each medical situation should be considered unique to each patient and all treatments individualized accordingly based on the respective physician’s medical judgment. AMO does not (1) warranty the accuracy or completeness of any clinical information that may be contained in this video, or (2) endorse or recommend any particular technique unless and to the extent such technique is expressly stated in the product labelling.

How has your practice changed since you began using the CATALYS® Precision Laser System?

We use the CATALYS® System femtosecond laser technology for all of our multifocal IOL implantations and also for most of our toric IOL implantations. For costs savings, we may implant a toric IOL without using the CATALYS® System, if a patient desires, but our bias is to use the CATALYS® System for toric IOLs as well.

We strongly prefer to use the CATALYS® System for patients with specific clinical indications such as dense cataracts. We educate our patients on the benefits of the CATALYS® System, and if they are appropriate candidates, then we encourage them to choose this technology.

PRECAUTION: The CATALYS® System has not been adequately evaluated in patients with a cataract greater than Grade 4 (via LOCS III); therefore, no conclusions regarding either safety or effectiveness are presently available.

Based on your experience, what valuable advice can you provide for mid- and late adopters of femtosecond laser technology?

First, it is key for the surgeon to determine if he or she is committed to the technology and to achieving the best results possible. Investing in a femtosecond laser for cataract surgery takes considerable effort, time and money. The surgeon must appreciate the nuances of cataract surgery and enhancing surgical outcomes for patients to make the investment worthwhile. For our practice, the technology was a natural fit.

Educating patients is also key. Our philosophy is to match our technology to the needs and wants of each patient, which includes consideration of the cost vs. benefits for our patients. The benefits vary considerably depending on a patient’s clinical presentation, and we are forthright in discussing what we perceive as any benefits that the CATALYS® System may have for each patient. We never pressure the patient to choose the CATALYS® System; we only educate them on this option. With this philosophy, we have found the financial viability of the CATALYS® System takes care of itself.

Given our practice’s enthusiasm and success with the platform, we often find ourselves wanting to use the CATALYS® System for a specific clinical reason in a patient who does not have the financial means to justify the expense. For those patients, we personally donate the patient interface and waive the CATALYS® System fee to offer what we think is best. That is a great feeling.



The CATALYS® Precision Laser System is indicated for use in patients undergoing cataract surgery for removal of the crystalline lens. Intended uses in cataract surgery include anterior capsulotomy, phacofragmentation, and the creation of single plane and multi-plane arc cuts/incisions in the cornea, each of which may be performed either individually or consecutively during the same procedure.


Patients with corneal ring and/or inlay implants, severe corneal opacities, corneal abnormalities, significant corneal edema or diminished aqueous clarity that obscures OCT imaging of the anterior lens capsule, patients younger than 22 years of age, descemetocele with impending corneal rupture, and any contraindications to cataract surgery.


Prior to INTEGRAL GUIDANCE System imaging and laser treatment, the suction ring must be completely filled with sterile buffered saline solution. If any air bubbles and/or a meniscus appear on the video image before treatment, do not initiate laser treatment. Before initiating laser treatment, inspect images created from the OCT data, surface fits, and overlaid pattern in both axial and sagittal views, and review the treatment parameters on the Final Review Screen for accuracy. Safety margins for all incisions are preserved only if Custom Fit Adjustments to ocular surface(s) are applied in accordance with the instructions for use. Purposeful misuse of the Custom Fit Adjustment to ocular surfaces can result in patient injury and complication(s), and therefore must be avoided. Standard continuous curvilinear capsulorrhexis (CCC) surgical technique must be used for surgical removal of the capsulotomy disc. The use of improper capsulotomy disc removal technique may potentially cause or contribute to anterior capsule tear and/or a noncircular, irregularly shaped capsulotomy. Verify that the suction ring is correctly connected to the disposable lens component of the LIQUID OPTICS Interface during the initial patient docking procedure.


The CATALYS® System has not been adequately evaluated in patients with a cataract greater than Grade 4 (via LOCS III); therefore no conclusions regarding either the safety or effectiveness are presently available. Cataract surgery may be more difficult in patients with an axial length less than 22 mm or greater than 26 mm, and/or an anterior chamber depth less than 2.5 mm due to anatomical restrictions. Use caution when treating patients who may be taking medications such as alpha blockers (e.g. Flomax®) as these medications may be related to Intraoperative Floppy Iris Syndrome (IFIS); this condition may include poor preoperative dilation, iris billowing and prolapse, and progress intraoperative miosis. These conditions may require modification of surgical technique such as the utilization of iris hooks, iris dilator rings, or viscoelastic substances. Surgical removal of the cataract more than 30 minutes after the laser capsulotomy and laser lens fragmentation has not been clinically evaluated. The clinical effects of delaying surgical removal more than 30 minutes after laser anterior capsulotomy and laser lens fragmentation are unknown. The LIQUID OPTICS Interface is intended for single patient use only. Full-thickness corneal cuts or incisions should be performed with instruments and supplies on standby, to seal the eye in case of anterior chamber collapse or fluid leakage. Patients who will undergo full-thickness corneal incisions with the CATALYS® System should be given the same standard surgical preparation as used for patients undergoing cataract surgery for the removal of the crystalline lens. During intraocular surgery on patients who have undergone full-thickness corneal incisions with the CATALYS® System, care should be taken if an eyelid speculum is used, in order to limit pressure from the speculum onto the open eye. Patients who will be transported between the creation of a full-thickness corneal incision and the completion of intraocular surgery should have their eye covered with a sterile rigid eye shield, in order to avoid inadvertent eye injury during transport. Patients must be able to lie flat and motionless in a supine position and able to tolerate local or topical anesthesia.


Complications associated with the CATALYS® System include mild Petechiae and subconjunctival hemorrhage due to vacuum pressure of the LIQUID OPTICS Interface Suction ring. Potential complications and adverse events generally associated with the performance of capsulotomy and lens fragmentation, or creation of a partial-thickness or full-thickness cut or incision of the cornea, include: Acute corneal clouding, age-related macular degeneration, amaurosis, anterior and/or posterior capsule tear/rupture, astigmatism, capsulorrhexis notch during phacoemulsification, capsulotomy/lens fragmentation or cut/incision decentration, cells in anterior chamber, choroidal effusion or hemorrhage, conjunctival hyperemia/injection/erythema/chemosis, conjunctivitis (allergic/viral), corneal abrasion/deepithelization/epithelial defect, corneal edema, cystoid macula edema, Descemet’s detachment, decentered or dislocated intraocular lens implant, diplopia, dropped or retained lens, dry eye/superficial punctate keratitis, edema, elevated intraocular pressure, endothelial decompensation, floaters, glaucoma, halo, inflammation, incomplete capsulotomy, intraoperative floppy iris syndrome, iris atrophy/extrusion, light flashes, meibomitis, ocular discomfort (e.g., pain, irritation, scratchiness, itching, foreign body sensation), ocular trauma, petechiae, photophobia, pigment changes/pigment in corneal endothelium/foveal region, pingueculitis, posterior capsule opacification, posterior capsule rupture, posterior vitreous detachment, posteriorly dislocated lens material, pupillary contraction, red blood cells in the anterior chamber (not hyphema), residual cortex, retained lens fragments, retinal detachment or hemorrhage, scar in Descemet’s membrane, shallowing or collapsing of the anterior chamber, scoring of the posterior corneal surface, snailtrack on endothelium, steroid rebound effect, striae in Descemet’s, subconjunctival hemorrhage, thermal injury to adjacent eye tissues, toxic anterior shock syndrome, vitreous in the anterior chamber, vitreous band or loss, wound dehiscence, wound or incision leak, zonular dehiscence.


Federal law (USA) restricts this device to sale by or on the order of a physician. The system should be used only by qualified physicians who have extensive knowledge of the use of this device and have been trained and certified.

© 2016 Abbott Medical Optics Inc. CATALYS, INTEGRAL GUIDANCE and LIQUID OPTICS are trademarks owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates.

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