BETTER IN EVERY WAYSurgical efficiency also has improved, with most cataract extractions performed in outpatient surgery centers with just a minimal degree of systemic anesthetics. Using topical anesthesia instead of a block is the trend and some are even ditching the IV for sublingual administration of sedation. Many surgeons are doing a dozen or more surgeries in a morning, and some do multiples more. The timing of this efficiency advancement is perfect: With about 500 new ophthalmologists completing training each year, not all of whom will work full time, the need will be great for each surgeon to do more cataract surgeries as our geriatric population swells.Safety, too, has improved, with phaco platforms offering forced infusion to maintain the anterior chamber and to reduce surge. While femtosecond lasers may not increase refractive accuracy, they can help some surgeons reduce complications by delivering a capsulorhexis and divided lens nucleus prior to entering the eye. As you’ll see from our Roundtable (page 26), not all surgeons agree about the current use of femtosecond lasers, but they do agree that future accommodating IOL designs could change that.
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