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Up Front | Apr 2011

EDITOR’S PAGE: The Allure of Auxiliary Technologies

Our readers know what it takes to run a successful ophthalmic practice. They know how to provide quality care to their patients, and they know how to deliver optimal postoperative outcomes. In some cataract surgery practices, these things are achieved by simply practicing safe and effective cataract surgery and listening to what visual outcomes patients expect to achieve postoperatively. In others, auxiliary technologies are partly responsible for the practice’s accomplishments.

The April issue of CRST Europe highlights four auxiliary technologies that, although not essential components of a cataract surgical center, compliment the practice and the services it provides. This is not to suggest that auxiliary technologies are necessary for a practice to be successful, nor should it suggest that practices that implement auxiliary technologies automatically achieve greatness. CRST Europe does wish, however, to acknowledge the allure of auxiliary technologies and encourage our readers to stay informed of the devices available to them.

The four technologies featured within this cover series are femtosecond lasers for cataract surgery, intraoperative measurement devices, microscopes and visualization systems, and capsular tension rings. We know that this list is not exhaustive. But from the feedback CRST Europe has received from its editorial board and from reviewing the programs of ophthalmic congresses worldwide, we have gleaned that these are among the hottest auxiliary technologies available to cataract surgeons.

Each category in this cover focus features contributions from key opinion leaders around the world. The opening article considers several practical considerations for the use of laser cataract surgery, including practice models, financial aspects and pricing strategies, and the coming availability of this technology for widespread use. I had the pleasure of interviewing Gerd U. Auffarth, MD; William J. Fishkind, MD; Michael C. Knorz, MD; Zoltan Nagy, MD; Kasu Prasad Reddy, MD; and Stephen G. Slade, MD, FACS, on their use of laser cataract surgery. What I found interesting was that most of these surgeons, with the exception of Drs. Slade and Nagy, do not have direct access to these lasers, as only a small number have been manufactured thus far. It might be a while before we see widespread use of laser cataract surgery, but it is increasingly apparent that this procedure boasts safer and more reproducible procedural steps. Once these lasers are available for commercial use, they may quickly become the gold standard in cataract surgery.

Michel Perez, MD; David F. Chang, MD; Farrell “Toby” Tyson, MD; Eric D. Donnenfeld, MD; Nienke Visser, MD; and Rudy M.M.A Nuijts, MD, PhD, describe the various intraoperative measurement devices that are growing in popularity, especially for toric IOL alignment. The benefit of incorporating such technology into a cataract surgery practice lies within the surgeon’s ability to fine-tune corneal refractive outcomes.

Two new-generation microscopes, the Leica M844 (Leica Microsystems, Inc., Bannockburn, Illinois) and the Lumera 700 (Carl Zeiss Meditec, Jena, Germany) have created buzz at the latest congresses. Damien F. Goldberg, MD; and James Khodabakhsh, MD, mention the crisp red reflex that each microscope provides. On a similar scale, Robert J. Weinstock, MD, discusses his use of a 3-D HD camera unit that attaches to standard surgical microscopes. This system allows Dr. Weinstock to view the surgical field on a large flat-screen panel display in 3D.

Lastly, three articles dedicated to the use of capsular tension rings (CTRs) explore the indications and complications, optimal insertion time, and implantation techniques. Monia Chéour, MD; Héla Mazlout, MD; Amal Marrakchi; Jihane Brour; Mounir Boughanmi; Wafa Triki; Houda Lajmi; and Abdelhafidh Kraiem, MD, point out that the addition of CTRs to their practice have provided a safer means to in-the-bag IOL implantation in patients with zonular dialysis. Mikel Mikhail; Khalid Hasanee, MD, FRCSC; and Iqbal Ike K. Ahmed, MD, FRCSC, suggest that late CTR implantation reduces zonular stress during surgery and increases IOL support and centration. One important consideration is perfecting your CTR implantation technique, and Bonnie An Henderson, MD; and Rupert Menapace, MD, share their methods of insertion.

CRST Europe is not suggesting that it is mandatory to run out and invest in these auxiliary technologies to increase the success of your practice, but it is wise to stay abreast to the latest developments in cataract surgery and evaluate how they may contribute to your own practice.

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