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Up Front | Feb 2014

The Meaning of Laser-Focused

While researching this month’s cover focus on laser-assisted cataract surgery, I stumbled upon an article on the Bloomberg News website suggesting that business tycoons commonly use the phrase laser-focused to describe how their company is capable of precisely aiming its attention.1 As I had entered the words laser and focus into my web browser in order to gather artistic ideas for the front cover of this issue of CRST Europe, I was thrown off-guard when my search resulted in a business article. By the time I finished reading the first paragraph, however, I acknowledged the relevancy of its content to our February cover focus.

Any way you slice it (pun intended), the idea of this article is that laser-focused and similar jargon such as focus of a laser and laser focus are simply words that one can use to portray the ability to singularly concentrate on an object, concept, or activity.

What if we apply this phrase to ophthalmology? What are surgeons laser-focused on? Lately, a great deal of effort has been concentrated on laser-assisted cataract surgery. Take, for instance, the large body of literature2-14 that has been published and the plethora of lectures and presentations15-17 that have been given on the subject.

One study that has surgeons talking, presented by Oliver Findl, MD, MBA, at the European Society of Cataract and Refractive Surgeons (ESCRS) meeting in Amsterdam this past October, showed that capsulorrhexis size and shape did not have a significant influence on postoperative IOL tilt, decentration, or anterior chamber depth.15 Findl concluded that good postoperative capsular bag positioning of modern IOL designs is relatively independent of the shape and size of the capsulorrhexis opening. The study included 300 surgeries performed by nine surgeons ranging in skill from experienced consultants to trainees.

Opinions on Findl’s results vary. Some surgeons agree with his conclusions, but others believe that laser capsulotomy increases the stability of refractive results and helps to prevent IOL tilt and decentration. In the hopes of presenting both sides of the debate in our cover focus, we summarized several studies and invited surgeons to comment on their positions on the subject. In a separate article, William F. Wiley, MD, explains how 3-D intraoperative OCT imaging can be used to align the capsulotomy with the natural resting place of the optic in the capsular bag.

Another area of interest in laser-assisted cataract surgery is lens fragmentation, and a sampling of techniques is outlined in our cover focus. For instance, Eric D. Donnenfeld, MD, creates two concentric circles (4.5 and 2.5 mm) and an X pattern to bisect the lens, whereas Detlef Holland, MD, and Ludger Hanneken, MD, select the laser fragmentation pattern depending on the density of the nucleus.

The femtosecond laser has several other functions for cataract surgery, including creation of clear corneal incisions and astigmatic keratotomy incisions. Over the next few years, as surgeons uncover even more ways to use this tool, debates regarding its role or roles in cataract surgery will likely persist.

But, just as CEOs and executives will continue to use the phrase laser-focused to convey an “image of precision and technological prowess,” according to the Bloomberg article, cataract surgeons will continue to apply their laser focus to optimizing postoperative outcomes. Today, laser capsulotomy and lens fragmentation are two techniques that give surgeons the opportunity to deliver precise and repeatable treatments and enhance surgical outcomes.

Laura Straub, Editor-in-Chief

  1. Buhayar N. Laser-focused CEOs proliferate as jargon infects speech. Bloomberg News website. http://www.bloomberg. com/news/2013-09-11/laser-focused-ceos-multiply-with-promises-from-ipads-to-macaroni.html. Accessed January 21, 2014.
  2. Kránitz K, Takacs A, Miháltz K, Kovács I, Knorz MC, Nagy ZZ. Femtosecond laser capsulotomy and manual continuous curvilinear capsulorrhexis parameters and their effects on intraocular lens centration. J Refract Surg. 2011;27(8):558-563.
  3. Nagy ZZ, Kránitz K, Takacs AI, Miháltz K, Kovács I, Knorz MC. Comparison of intraocular lens decentration parameters after femtosecond and manual capsulotomies. J Refract Surg. 2011;27(8):564-569.
  4. Kránitz K, Takacs A, Miháltz K, et al. Intraocular lens tilt and decentration measured by Scheimpflug camera following manual or femtosecond laser-created continuous circular capsulotomy.J Refract Surg. 2012;28(4):259-263.
  5. He L, Sheehy K, Culbertson W. Femtosecond laser-assisted cataract surgery. Curr Opin Ophthalmol. 2011;22:43-52.
  6. Reggiano-Mello G, Krueger RR. Comparison of commercially available femtosecond lasers in refractive surgery. Expert Rev Ophthalmol. 2011;6(1):55-65.
  7. Hatch KM, Talamo JH. Laser-assisted cataract surgery: benefits and barriers. Curr Opin Ophthalmol. 2014;25(1):54-61.
  8. Palanker D, Blumenkranz MS, Andersen D, et al. Femtosecond laser-assisted cataract surgery with integrated optical coherence tomography. Sci Transl Med. 2010;2(58):58ra85.
  9. Masket S, Sarayba M, Ignacio T, Fram N. Femtosecond laser-assisted cataract incisions: architectural stability and reproducibility. J Cataract Refract Surg. 2010;36(6):1048-1049.
  10. Tackman RN, Kuri JV, Nichamin LD, Edwards K. Anterior capsulotomy with an ultrashort pulse laser. J Cataract Refract Surg. 2011;37(5):819-824.
  11. Yeilding RH, Villar-Kuri J, Naranjo-Tackman R, et al. Evaluation of size and shape of anterior lens capsules after photodisruption laser capsulotomy and continuous curvilinear capsulorrhexis. Invest Ophthalmol Vis Sci. 2009;50:Eabstract 5394.
  12. Friedman NJ, Palanker DV, Schuele G, et al. Femtosecond laser capsulotomy. J Cataract Refract Surg. 2011;37:1189-1198.
  13. Lawless M, Bali SJ, Hodge C, Roberts TV, Chan C, Sutton G. Outcomes of femtosecond laser cataract surgery with a diffractive multifocal IOL. J Refract Surg. 2012;28(12):859-864.
  14. Abell RG, Davies PEJ, Phelan D, Goemann K, McPherson ZE, Vote BJ. Anterior capsulotomy integrity after femtosecond laser-assisted cataract surgery. Ophthalmology. 2014;121(1):17-24.
  15. Findl O. Influence of rhexis size and shape on postoperative IOL tilt, decentration and anterior chamber depth. Paper presented at: the XXXI Congress of the ESCRS; October 7, 2013; Amsterdam, Netherlands.
  16. Davidorf JM. Impact of Capsulorrhexis Morphology on the Predictability of IOL Power Calculations. Paper presented at: American Academy of Ophthalmology Annual Meeting; November 11, 2012; Chicago.
  17. Davison JA. Intraoperative capsule complications during phacoemulsification and IOL implantation. Paper presented at: the ASCRS 2012 Annual Meeting; April 20-24, 2012; Chicago.