Studies have shown that patient satisfaction correlates with getting the best possible visual result and the SMI system is a new way of improving the results of cataract operations by allowing more accurate intraocular lens placement. This will lead to more accurate results than have been previously possible.

Oliver Kersting, head of SMI’s ophthalmic systems division explains “This is a measurement device that’s usually used preoperatively. With it, we can take a high-resolution image of the eye and a keratometry reading. Then, in the OR, there’s the Surgery Pilot system, a computing device that takes the image from the surgical microscope and, on a computer monitor, automatically registers it with the preop image. The Surgery Pilot image allows you to plan the different steps of cataract surgery based on data from different sources and the original measurements from the reference unit. You can set the incision axis, the angles of limbal relaxing incisions, and the capsulorhexis position and diameter relative to the diagnostic measurements. the system also has a toric overlay that shows the surgeon the implant axis on a live surgical image.”

Dr Troski will be using the SMI system routinely  so that patients can benefit from this new cataract surgery technique.

Study finds less endophthalmitis after sequential bilateral cataract surgery than unilateral surgery
A survey of members of the International Society of Bilateral Cataract Surgeons shows no cases of bilateral endophthalmitis occurring among 95,606 eyes (a sample size more than six times larger than the ESCRS endophthalmitis study) that had immediately sequential bilateral cataract surgery. The overall rate of postop infection was calculated as 1 in 5,759. The authors also conducted a literature review to determine the recent incidence of postop endophthalmitis in unilateral cataract surgery with and without the use of intracameral antibiotics. Infection rates were significantly reduced with intracameral antibiotics to 1 in 14,352 cases. Journal of Cataract & Refractive Surgery, December 2011

This study suggests that BISCS is at least as safe as having surgery on one eye at a time. (generally the rate of endophthalmitis quoted is around 1 in 1000 cases)
Dr mark Troski is able to offer the option of having both cataracts removed at the same visit to theatre for suitable patients.
He follows international guidelines to ensure this as safe as possible and allows patients (especially those who live in rural and remote areas) to minimise their travel to Melbourne
Please contact Dr Troski or his staff if you would like to consider this option.

We decided to compare our own results with these:

We used Dr Troski results over the last 50 consecutive patients to compare with Dr Cionni and Dr Donnenfeld.

In Dr Cionni “manual” series 64% were within 0.25d of the expected outcome compared with 83% using the laser.

In Dr Donnenfeld group of lacs patients 71% were within 0.25d

In Dr Troski group of “manual” patients had 84% within 0.25d
we also had 100% within 0.50d.

Dr Cionni also reported that in the “manual” group 27% could see 6/6 (20/20) compared with 58% in the femto lacs group.

Dr Troski group had 94% of patients seeing 6/6 (20/20) or better.

American surgeons who have used the laser (many of whom have financial interests in the laser companies) are very enthusiastic about it. Many other surgeons in the USA are very concerned that the laser is more about marketing than real surgery benefits.
There is still no clear evidence that the enormous cost of these machines (half a million dollars) is reflected in the improved results that the laser is supposed to produce. One of the main advantages is said to be a reduction in cataract surgery complications, but with so little data it really is not clear whether the laser does represent a meaningful reduction in the complications of cataract surgery. It is also possible that the laser may cause some new complications itself that have not been seen with current “state of the art” phacoemulsification cataract surgery.

This is certainly the hottest topic in cataract surgery at the moment.

Mark Troski, M.D., a surgeon devoted exclusively to cataract surgery, described a trend that many surgeons have been waiting for over the better part of the last decade: Alcon’s ReSTOR toric multifocal IOL.

In his unfortunately time-constrained talk, Dr. Troski managed to systematically “myth bust” what he called the “7 Myths of Multifocals”: multifocals don’t work, particularly in patients with astigmatism (the latter addressed specifically by the new lens); patients still need glasses with multifocals; monovision works better than multifocals; small (0.50 D) errors don’t need a multifocal; multifocals don’t work well in myopia; multifocals don’t work monocularly; and multifocals don’t work for emmetropic presbyopes. To bust each myth, Dr. Troski presented published evidence as well as ecstatic blurbs from some of his most enthusiastic patients.

Multifocals, he concluded, do work. However, he conceded, it is essential for surgeons to be meticulous not only in their pre-op measurements and intraoperative performance, but in patient selection. Moreover, noted Dr. Moshegov, it does seem that sometimes, it may be that surgeons are too quick to place the blame on the lens for suboptimal outcomes, when it may well be one of the other conditions described in the symposium—post-op dry eye, for instance—which may be responsible for unhappy patients.

The full conference report here

The most exciting development in cataract surgery is the new femtosecond laser assisted cataract surgery I had the opportunity to be shown the new machine (currently there is only one in Australia) by the surgeon who performed the first treatment in the world.
He has performed hundreds of these procedures and feels very strongly that the laser makes cataract surgery safer and more precise. I am sure this is the future of cataract surgery and I am excited about being able to offer this to my patients when it is available.

I will be attending the upcoming APAO conference in Sydney on the 20-24th of March 2011.

As an invited speaker I will be discussing my experience with multi focal implants. Please contact me if you have any cataract related questions.