Each surgeon will personalize the way they perform this operation.
The changes that made the most difference to the way I operate evolved over the first 500 operations. Perhaps starting off by incorporating these changes earlier will shorten any learning curve.
The biggest change in my technique was using bimanual cortical aspiration to remove the cortex. This reduced the operating time by 3 minutes per cataract as the sub-incisional cortex was no longer a problem.
Taking time to re-dock on an eye that was not centered in the Patient Interface initially, was time well spent. Starting to laser on a tilted eye is unwise, when a few minutes more diligence would result in a well centered complete capsulorhexis.
Taking time to have a mobile nucleus with good hydrodisection improves the safety of the operation. The initial fear of “blowing out” the posterior capsule has proved to be unfounded.
After performing 3000 cases I have decided to abandon using the laser to make the main incision as the site is not always predictable. I now use a metal blade to make the main incision.
There is no doubt in my mind that the femtosecond laser makes cataract surgery, which is a safe operation with excellent results, even safer.