Bladeless custom femtosecond laser-assisted refractive cataract surgery? let's give our latest breakthrough surgical technique a name that fits.

To the Editor: For half a decade now, cataract surgeons in everincreasing numbers are employing the femtosecond laser for arcuate and corneal incisions, capsulotomy, and lens fragmentation before they perform the somewhat reduced part of manual surgery, the removal of the lens fragments and the intraocular lens implantation. The technology has been discussed in peerreviewed journals, at conventions, and also among the public, who is always fascinated by any procedure that contains the magic word “laser.” Half a decade is an appropriate time to quote Shakespeare: What’s in a name? Indeed, the new technology does not suffer a shortage of names. A small review recently came up with 28 different procedure names, but chances are there are more around. Among those in use in surgical centers are “custom laser cataract surgery,” “laser cataract refractive surgery,” “femtosecond laser-assisted cataract surgery” (which comes close to being a widely accepted term), “laser lens surgery,” and more exotic creations such as “bladeless surgery” or the rather nondescript “advanced technology” (which could also describe the latest high-definition TV screen or some super-smooth fiveor six-layer razor blade).1-6 We believe that it is time to give the procedure a name that captures the excitement of the users and reflects its nature. Unified terminology can certainly do without containing the word “refractive.” All cataract surgery is refractive these days: there are many patients who come to us primarily to have their refractive error corrected by exchanging a lens sometimes only slightly afflicted by cataract with an intraocular lens that is right for them and their individual lifestyle. All we do is “custom.” We operate on a patient according to the individual’s needs. The next one to lie down under the operating microscope may have different needs and will be treated according to his or her “custom” need. But certainly the precise physical characteristic of the technology, the “femtosecond,” a laser pulse whose time duration is of the order of a femtosecond (10 to 15 seconds), is irreplaceable? Probably for now, but what do we know about a not-so-distant future in which another laser with a different pulse, not yet developed, might possibly perform different steps of surgery even better, even more precise? Therefore, let us call it laser-assisted cataract surgery (LCS) and be aware that in the minds of our patients, as The Bard used to say, this rose would smell as sweet by any other name.