Surgical Efficiency in Cataract Surgery

Surgical efficiency is pivotal for ophthalmologists. How well a procedure can be streamlined without compromising safety and effectiveness not only influences the experiences of the surgeon, staff, and patients, but it is increasingly tied to postoperative outcomes. In cataract surgery, focusing on key intraoperative metrics such as surge, total ultrasound time, and fluid consumption may lead to improved efficiency (see sidebar). These three considerations can be particularly helpful when integrated with a femtosecond laser-assisted cataract surgery (FLACS) technique.

I have used several modern phaco systems with varying levels of surgical efficiency. Today, the gold standard is the Centurion Vision System (Alcon) (1, 2, 3, 4, 5). Additionally, my colleagues and I recently conducted a study showing equivalent surgical efficiency with the R-Evo Smart (BVI Medical).

Comparative study
 

We conducted a prospective, consecutive-comparative study of 301 eyes undergoing routine phaco surgery or FLACS with either the R-Evo Smart (n = 155) or Centurion (n = 146) at two different private practices – Oftalvist Clinic in Madrid and Alicante, Spain – between May and October 2023. When FLACS was performed, we used the Catalys Precision Laser platform (Johnson & Johnson Vision). In all cases, we performed a 5-mm capsulotomy through a 2.2-mm temporal clear corneal incision. There was no statistical significance in mean cataract grade between the R-Evo and Centurion groups (3.07 ±0.78 vs 2.96 ±0.85; P = .12), respectively.

Surgical efficiency was objectively measured by total ultrasound time during lens removal and fluid consumption during both lens removal and irrigation and aspiration (Table 1). Drainage bag weighting was used to measure fluid consumption in the R-Evo group. The mean total ultrasound time was 18.99 ±12.85 seconds and 40.24 ±21.91 seconds (P<.01) in the R-Evo Smart and Centurion groups, respectively, and the mean total estimated fluid aspirated/drainage bag weighting was 53.00 ±14.56 g and 54.33 ±14.88 cc (P<.21), respectively. We also analyzed results in the subgroup of routine phaco eyes. In this group of 98 R-Evo Smart eyes and 63 Centurion eyes, the mean total ultrasound time was 19.96 ±11.20 seconds and 42.84 ±28.35 seconds (P<.01), respectively, and the estimated fluid aspirated/drainage bag weighting was 55.95 ±14.76 g and 55.97 ±13.62 cc, respectively (P=.49).

Our results showed a significant reduction in ultrasound time with the R-Evo Smart technology, and in some cases, the ultrasound time was almost half that of the Centurion. This is likely due to the R-Evo Smart’s Minimal Stress system, which maintains consistent elongation of the phaco tip regardless of the cataract density. There was, however, a correlation between cataract grade and ultrasound time in both groups. The R-Evo Smart also incorporates an Agile Fluidics system to adjust the IOP based on the aspiration demand, thereby reducing the surge effect. There was no statistically significant difference in fluid consumption between groups.

Improved efficiency and predictability
 

Surgeons who prioritize efficiency often seek improved predictability. Consistency in surgical time, reduced variability in outcomes, and a streamlined workflow allow surgeons to maintain focus and confidence during surgery, contributing to better outcomes for patients.

I appreciate how the R-Evo Smart technology maintains a stable anterior chamber as well as IOP during surgery while efficiently managing fluid consumption. In my opinion, this allows a seamless surgical experience for myself as well as my staff and patients. The enhanced efficiency contributes to a calmer surgical environment. This more predictable and efficient surgical process has also translated into shorter procedure times, reduced stress for the surgeon and staff, and ultimately, a better experience for patients.

Benefits of streamlined efficiency in FLACS
 

FLACS has gained traction in recent years due to its precision in performing capsulotomies and nucleus fragmentation as well as reducing the need for ultrasound energy during phacoemulsification. The learning curve for FLACS has significantly shortened over the past decade, making it easier for surgeons to incorporate into their practice. When paired with a reduction in ultrasound energy and efficient cataract removal, both of which can be achieved with the R-Evo Smart system, the benefits of FLACS are further amplified.

In my hands, the procedure feels faster and smoother, with less stress on the eye. Moreover, integration of the R-Evo Smart with a FLACS technique allows me to perform more surgeries in a single session without compromising safety and effectiveness. This increased throughput not only improves my ability to treat more patients, but it also creates a predictable and organized workflow that me and my staff have come to depend on during a time of increased demand for cataract surgery. As the surgeon shortage continues, it will become increasingly important to reduce surgical time to accommodate our growing patient population (6).

Conclusion
 

Surgical efficiency in cataract surgery is a multifaceted goal that impacts patient outcomes, surgeon satisfaction, and overall procedural success. By focusing on key intraoperative metrics such as surge, ultrasound time, and fluid consumption, surgeons can make informed decisions about the technology and techniques they use in the operating room.

The R-Evo Smart phaco technology has shown itself to be a promising tool for improving efficiency, especially when combined with FLACS. Its ability to reduce ultrasound time and optimize fluidics leads to faster surgeries, fewer complications, and improved patient outcomes.

As cataract surgery continues to evolve and the population with cataracts grows, our focus on efficiency remains paramount. Modern phaco systems like the Centurion Vision System and R-Evo Smart are paving the way for safer, faster, and more predictable outcomes—benefits that extend to surgeons, staff, and most importantly, patients.