AMSURG Partner Dr. David Folden Creates New Instrument to Improve Laser Cataract Surgery Process

AMSURG partner David Folden, M.D., North Metro Surgery Center, Blaine, Minn., created a new instrument designed to improve the process of opening femtosecond laser-created corneal incisions for cataract surgery.   Tell me about the Folden Femto Double-Ended Dissector and how you came up with the idea. I designed the Folden Femto Dissector to improve the process of opening femtosecond laser-created corneal incisions during cataract surgery. The instrument is double-ended with widths of 0.7 mm at one end and 1.2 mm at the other.  The instrument’s tip and edge design are the critical, differentiating features that make my instrument unique.  It combines a perfect semi-blunted leading tip with a sharp edge.  Its purpose is to enhance efficiency and control for the surgeon and improve safety, comfort, and outcomes for patients undergoing laser cataract surgery.   Incisions created by the femtosecond laser have perfect precision and are reproducible among all patients in a way that cannot be duplicated by the human hand.  The incisions do, however, contain tissue bridges that effectively maintain the incision “closed” until opened by the surgeon.   I found the existing available instruments were often cumbersome and difficult to manipulate when working with delicate corneal tissue. Often, multiple instruments would be necessary to open the incisions resulting in longer surgical times, disruption to the surgical flow, and greater trauma to the corneal tissue.  I wanted to design an instrument that would be easy to use and more efficient for the surgeon, and be less likely to cause abrasions and post-operation foreign body sensations for the patient.    How does the femtosecond laser assist in cataract surgery and how is the Folden Femto Dissector utilized in laser cataract surgery?  The femtosecond laser assists in three ways:It creates all corneal incisions, allowing for “bladeless” surgery.It pre-treats and “softens” the cataract, which minimizes the energy necessary to remove the cataract.  This reduces swelling and inflammation, enhancing visual recovery. It treats astigmatism, improving visual quality and reducing the need for glasses following cataract surgery.   My instrument is used to open the femtosecond laser-created corneal incisions.  Depending on surgeon preference and the specifics of each laser treatment, incisions will vary in size and location in the cornea.  Incisions that are larger and more centrally located are relatively easy to open.  Incisions that are microscopic and more peripheral are more difficult to open.  My instrument is double-ended with two sizes, which allows opening of the various incision sizes that surgeons use in their personalized surgical procedure – from microscopic to more standard sized incisions.  More importantly, the instrument’s unique semi-blunted leading tip and sharp edge design allows for “clean” opening of central incisions, as well as the more challenging peripheral incision.  This offers improved efficiency and can save surgeons a great deal of time and frustration. It improves the opening of any incision, regardless of its size or location in the cornea.   What are your plans for the Folden Femto Dissector? There was a lot of enthusiasm and good feedback from surgeons and industry leaders at this year’s American Society of Cataract and Refractive Surgery (ASCRS) annual meeting.   Individual surgeons, frustrated with their current instrumentation, has led them to actively search for instruments with more innovative designs, and the feedback on the Folden Femto Dissector has been very positive.  LENSAR, a leading manufacturer of femtosecond laser technology in cataract surgery, is very enthusiastic about my instrument and uses it in many of their centers throughout the country.  The design and ease of use is helpful for new laser cataract surgeons and this simplifies the training process for LENSAR.   The Folden Femto Dissector is manufactured by Rhein Medical and became commercially available to surgeons worldwide in the first quarter of 2015.   I feel that its unique design improves efficiency in the operating room and helps with patient outcomes.  For these reasons, it’s in a strong position to become the instrument of choice for corneal incisions in laser cataract surgery.   It is getting a good deal of publicity through articles in trade journals, magazines and local newspapers, as well as Rhein advertisements.   How long did it take to design and manufacture the tool from start to finish? It took about a year and a half from start to finish.  The process started with an idea and initial discussion of the concept with an interested manufacturer.  Design drawings resulted in the production of prototype instruments, which are used in surgery.  The cycle continued with adjustments to the drawings, modifications of the prototypes, and use in surgery until the final product was deemed perfect.   Now is the fun part; using it in surgery and getting the word out to laser manufacturers and other individual surgeons has been an enjoyable aspect of the overall process.   Is the device’s popularity and publicity taking you away from your patients and affecting your surgery schedule? Actually, it’s quite the opposite. The instrument’s design is easy to use and doesn’t require much instruction.  If anything, it has increased patient interest in me as a surgeon.  Patients are interested in working with surgeons that have experience and are innovative, improving the surgical experience for everyone.   This is bringing more patients to my center for cataract surgery, and so my surgery schedule is actually increasing.  Being able to help as many patients as possible is my goal, and I never intended that my instrument would take me away from my primary professional interests.   What is the best part about designing the Folden Femto Dissector? It’s something that I envisioned, initiated, and completed, resulting in a final product that improves surgery for surgeons and outcomes for patients – and that provides the greatest satisfaction.  Its design is quite simple and practical, but enhances the surgical experience for everyone.   Dr. Folden is a Minneapolis-area ophthalmologist who specializes in cataract and refractive surgery. His interest and experience in cataract surgery includes Micro-Incision techniques (MICS) and the use of the LENSAR femtosecond laser. He is also a partner at North Suburban Eye Specialists, a technologically leading eye care center and regional hub for patients seeking cataract, LASIK, corneal and glaucoma eye surgeries. Dr. Folden received his medical degree from the University of North Dakota. He completed an internship at Hennepin County Medical Center (HCMC) and his ophthalmology residency at the University of Minnesota.