Review of the year 2010

Cataract & Refractive 2010

2010 has witnessed a revolution in the use of femtosecond laser technology for cataract surgery, interesting developments in imaging and diagnostics and a big rise in the popularity of premium lenses. Alessandro Franchini, University of Florence, Italy, walks OTEurope through the highs of the year as well as the changes he has encountered.

By Alessandro Franchini

A. I still don't know if the new generation of femtosecond lasers for cataract surgery is the most important innovation of the year, but it is surely the most exciting for the future.

For me, being able to perform surgery with laser anterior capsulotomy, corneal incision - which can be used as cataract tunnel - paracentesis, relaxing incisions and so on is a great benefit. Also, an OCT guided nuclear fragmentation, will probably increase refractive results, reducing the risk of complications such as posterior capsule rupture, endophthalmitis and endothelial cell density loss. In fact, the first clinical results show that femtosecond laser really has the potential to cut the nucleus into the desired size and shape.

Therefore, even if there are still many questions that need to be answered and the clinical trials are still ongoing, I believe that femtosecond cataract surgery will further penetrate the market in the future, allowing our patients to take full advantage of all the benefits of premium IOLs.

Q. Have you noticed any changes in trends within imaging and diagnosis during the course of the year? If so, how has this affected you?

A. In this field I have added the evaluation of the nucleus hardness to my preoperative protocol. I have been using the software Nucleus Grading System of the Pentacam (Oculus) that measures and graduates the lens density in an objective and reproducible manner for this purpose. I have found this to be useful when deciding upon the best settings for the machine and obtaining homogeneous groups for scientific studies.

Q. Has there been any rise in popularity for any one technique/treatment amongst cataract and refractive surgeons?

A. During this year, we have witnessed an

ever-increasing dissemination of all premium lenses in general but especially toric lenses. These lenses are very interesting. The implantation is very safe and easy, and the postoperative refraction is now stable. This makes it possible to obtain a predictable correction of

pre-existing corneal astigmatism. In fact, the latest models guarantee high rotational stability without the risks of severe surgical and postoperative complications.

Q. How have the changes within your field affected your practice and every day work?

A. During 2010, the most important changes for my practice have been the management of patients' expectations, especially at a time of economic crisis as we have experienced over the past few years. Newspapers and the Italian media in general feature many ads that convince people any result is possible without any risks. So this year, I have found that much more time is spent in educating and informing my patients of the risks involved so that they have realistic expectations of the outcomes of surgery.

Q. Which areas, techniques or treatments do you believe will have the most impact next year and why?

A. I think that the whole premium lens market will see a big increase in the coming months, particularly the presbyopic lens market. In fact, all ophthalmic surgeons have been waiting for years for a lens that is capable of simultaneously improving distance, intermediate and near visual acuity.

Having reviewed initial results with the dual optic accomodating IOL Synchrony, I am convinced that this lens offers the best option for presbyopic patients today. However, at the moment cost is still a major problem.

In the future, cataract surgeons who do not implant premium IOLs will face many problems in satisfying their patients' wishes. There will always be an alternative offer around the corner.