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    Laser refractive cataract surgery: Benefits in the eye of the beholder

    Conventional phaco preferred by some, while transition to LRCS may appeal to others

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    Dr Steve A. Arshinoff
    As the number of published studies investigating laser refractive cataract surgery (LRCS) grows, the information they provide is fuelling an ongoing debate about the role of this new procedure.


    Dr Barry S. Seibel
    Dr Steve A. Arshinoff discussed why he still prefers conventional phacoemulsification, whereas Dr Barry S. Seibel explained the reasons underlying his transition to LRCS.

    Dr Arshinoff, clinical instructor, Department of Ophthalmology, University of Toronto, Ontario, Canada, and adjunct assistant clinical professor of ophthalmology, McMaster University, Hamilton, Ontario, Canada, explained his viewpoint on LRCS with reference to the evolutionary concept of the 'non-zero sum'. The idea, as stated by Robert Wright, is that the world tends to amalgamations in endlessly increasing complexity, as long as the sum of benefits to the amalgamating parties exceeds zero.

    Against those terms, Dr Arshinoff questioned whether the results with LRCS are better than those achieved in the hands of an excellent surgeon, or if instead, LRCS simply introduces different risks and at the same time may severely limit the potential market.



    For perspective, Dr Arshinoff contrasted LRCS with previous innovations in ophthalmology — including IOLs, ophthalmic viscosurgical devices, phacoemulsification, limbal relaxing incisions, and toric and multifocal IOLs — each of which might be considered a true advance for bringing forth novel and distinct advantages.

    However, he contended the same cannot be said for femtosecond lasers in cataract surgery.

    "It is clear to me that there is an advantage of using the laser to soften the lens and thereby reduce phaco energy use, especially in eyes with dense cataracts," Dr Arshinoff said. "However, whether the laser is better for capsulotomy and making the cataract incisions is still debatable considering reports of increased capsule tears with laser capsulotomies and laser surgical incisions that don't seal as well as those made with diamond knives.

    "Furthermore, while the refractive predictability may be better using the laser for LRIs, surgeons can easily adjust the outcome of a manual procedure at the slit lamp," he explained.

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