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Meet Dr. Faktorovich : Femtodynamics Textbook

A Guide to Laser Settings and Procedure Techniques to Optimize Outcomes with Femtosecond Lasers

Femtodynamics is a new, comprehensive text that presents a practical approach to optimizing laser settings and procedure techniques for performing LASIK, intracorneal ring segment placement, and other corneal procedures with currently available femtosecond lasers. Dr. Ella Faktorovich has provided detailed photographs and illustrations to demonstrate the techniques for optimizing procedure outcomes. The author guides you step-by-step through common procedures while providing a detailed approach to managing and preventing possible complications.

Topics covered include:

  • Strategies for centration
  • Optimizing energy delivered to the cornea
  • Improving quality of dissection
  • Techniques for customization based on anatomic and corneal features

As the first book on femtosecond laser application to corneal surgery, Femtodynamics: A Guide to Laser Settings and Procedure Techniques to Optimize Outcomes with Femtosecond Lasers is a useful guide for beginning surgeons as well as surgeons looking to develop or enhance their working knowledge of femtosecond lasers.

Foreword by Barry S. Seibel, M.D. (author of Phacodynamics textbook on cataract surgery)

Femtosecond lasers have revolutionized lamellar corneal surgery and, after a relatively few years, are becoming the dominant and accepted gold standard of LASIK flap creation, rapidly overtaking the decades-old mechanical microkeratome technology. Surgeons were accustomed to having relatively little control over the latter technology, essentially being limited to a choice in ring size and footplate depth and then, in most cases, making a leap of faith as the flap was created without visualization. Femtosecond lasers, in addition to offering greater precision and safety than their mechanical counterparts, also offer the surgeon much greater visualization and control over the procedure. However, this control is predicated on a thorough understanding of the technological principles on which the lasers operate.

Femtodynamics represents a breakthrough for surgeons seeking to understand and more importantly apply this new technology effectively. I am personally honored that Dr. Faktorovich has chosen my textbook Phacodynamics as a model for her work. Like my book on phacoemulsification surgery, Femtodynamics studies the fundamental principles on which the technology and microsurgical maneuvers are based, empowering surgeons to intelligently apply these principles rather than simply memorize generalized procedural steps and settings that may not be appropriate for each individual patient. The numerous excellent schematic drawings are complimented by photos to elegantly communicate a cornucopia of tools for intraoperative and interoperative adjustments, both in terms of machine parameters, as well as surgical techniques.

Femtodynamics better prepares the surgeon to deal with opaque bubble layers and variable flap adhesions by proper machine and technique adjustments. It additionally imparts an understanding of flap architecture design relative to unique patient anatomy and excimer ablation plans. Rather than simply list dogmatic settings, Dr. Faktorovich explains the logic behind adjusting such parameters as spot separation, pulse energy, side cut angle, hinge width, etc, based on intraoperative visual and tactile feedback. The surgeon is therefore able to avoid inadvertent obstacles imposed by improperly optimized settings and, moreover, can harness the technology intelligently and proactively to facilitate more efficient, effective, and safer surgery.

Barry S. Seibel, MD
Clinical Assistant Professor of Ophthalmology
University of California, Los Angeles

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Table of Contents

Chapter 1: History and Applications of Femtosecond Lasers
Priniciples of laser-matter interaction
Femtosecond lasers
Applications of femtosecond lasers
Chapter 2: Femtosecond Lasers in Corneal Surgery
Mechanism of corneal femtodissection
Femtosecond laser systems for corneal femtodissection
Femtosecond LASIK flap
Femtosecond channels for Intracorneal Ring Segments
Femtosecond corneal transplantation and other procedures
Chapter 3. Principles of Femtodynamics
Centration process
Quality of dissection
Opaque Bubble Layer
What is OBL and where does it come from?
OBL due to high energy
OBL due to low energy
OBL as a guide to optimizing laser settings and procedure techniques
Postoperative findings
Chapter 4. LASIK with AMO Femtosecond Lasers: Laser Settings
Technical features of AMO laser systems (IntraLase and iFS)
Overview of laser settings for LASIK flap creation
Pocket specifications
Pocket On/Off
Pocket depth
Pocket width
Pocket-flap overlap
Pocket ramp
Spot separation
Pocket energy
Pocket position
Hinge parameters
Hinge position
Hinge angle
Flap bed parameters
Flap bed spot separation
Flap bed energy
Flap diameter
Flap thickness
Flap thickness in patients with scars and epithelial basement membrane dystrophy
Side cut parameters
Side cut angle
Side cut energy
Chapter 5. LASIK with AMO Femtosecond Lasers: Procedure Techniques
Overview of procedure techniques for LASIK flap creation
Positioning the suction ring
Centering on the line of sight
Strategies for maximizing stromal bed exposure in eyes with decentered line of sight
Docking the applanation cone
Head and eye position
Avoiding parallax error during docking (By Barry Seibel, M.D.)
Avoiding false meniscus
Fine-tuning flap centration on the video display
Moving the pocket close to the meniscus
Centering the flap on the optical zone
Lifting the flap
General principles
Technique 1
Technique 2
Repositioning the flap
General principles
Technique 1
Technique 2
Repositioning the flap if stretch striae are present
Enhancement techniques
Chapter 6. LASIK with AMO Femtosecond Lasers: Getting Started
Mastering applanation
Mastering flap lift
Optimizing energy settings: where to begin?
Postoperative findings
Chapter 7. LASIK with AMO Femtosecond Lasers: Troubleshooting
Chapter 8. LASIK with Emerging Femtosecond Lasers
Ziemer Femto LDV
Technical features of Ziemer Femto LDV laser system
System settings for LASIK flap creation
Procedure techniques for LASIK flap creation
Trouble shooting
Technical features of VisuMax laser system
Overview of LASIK flap creation
Technical features of the Femtec laser system
Overview of LASIK flap creation
Chapter 9. Channel Creation for Intracorneal Ring Segments
Laser settings
Procedure techniques
Chapter 10. Femtosecond Laser Keratoplasty (By Roger F. Steinert, M.D.)
Penetrating keratoplasty
Lamellar keratoplasty
Future directions
Chapter 11. Future of femtosecond laser technology
Femtosecond lenticular extraction (FLEx)
Femtosecond laser astigmatism correction (FLAC)
Femtosecond laser intrastromal correction of presbyopia (intraCOR)
Femtosecond lens surgery (FLeS)
Femtosecond assisted corneal biopsy (FAB)
Femtosecond assisted limbal stem cell harvesting
Femtosecond glaucoma surgery
Femtosecond assisted high resolution tissue imaging

While some of us are lucky to have perfect vision throughout our lifetime, many are not. Impairments can be the result of problems in the way our eyes are built or in some cases, changes take place over time.

ABC News Anchor, Dr. Dean Edell reviews the exciting advances of IntraLASIK and sites Dr. Faktorovich as the first surgeon in San Francisco to perform this important procedure.

"WOW! What a wonderful experience. From the initial consultation through the completion of surgery..."

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