The future of laser-assisted cataract surgery: Clinical results and patient flow

August 2011‧Eye World

The future of laser-assisted cataract surgery: Clinical results and patient flow

   When a new technology emerges, especially one as advanced and somewhat controversial as femtosecond laser-assisted cataract surgery, surgeons want information. Their most recent source was the ASCRS and EyeWorld-sponsored webinar entitled, "The future of laser-assisted cataract surgery: Clinical results and patient flow."

   Alan B. Aker, M.D., Boca Raton Fla., logged on to the webinar with specific questions in mind: Is the femtosecond for cataract laser worth pursuing? Can a business model be developed that will justify the capital outlay necessary to bring one into an already successful cataract practice? How do surgeons present or "sell" this to their patients? "A desire to get answers to these questions is what is driving many of us to participate in these webinars, since there is very little experience with the laser," Dr. Aker said. "We're looking to gain information from the early adopters of the technology regarding its integration and acceptance by patients."

   Webinar panelists included John A. Vukich, M.D., Madison, Wisc., William J. Fishkind, M.D., Salt Lake City, Utah, Eric D. Donnenfeld, M.D., East Meadow, N.Y., Robert J. Cionni, M.D., Salt Lake City, Stephen S. Lane, M.D., Minneapolis, and Kerry D. Solomon, M.D., Charleston, S.C.

   Dr. Aker was one of nearly 200 participants who viewed the web-based presentations. A survey after the webinar revealed that 100% of those responding would recommend the ongoing series to a colleague, according to Laura Johnson, ASCRS director of education. "The webinar is a great construct for disseminating information in a new emerging technology," said Tyrie Jenkins, M.D., Honolulu. "We are tapping into some of the pioneers in the industry. I think it's generous of them to share their experience, and I appreciated that the webinar wasn't sponsored by industry." Specifically, Dr. Jenkins said she liked hearing from early adopters about how to integrate the system into a practice in terms of patient flow, financing, and staff training. She learned that, "A lot of it is making sure your staff is fully trained and up to speed with what you're doing and developing the collateral, such as patient information booklets, so the patients understand what you're doing." Two of the participants, including Lawrence B. Katzen, M.D., Palm Beach County, Fla., said they were disappointed that the webinar did not go into more detail about the pricing structures involved, from paying for the technology to charging patients.

   "I was disappointed in the information that was presented regarding how it is being paid for," Dr. Katzen said. "It adds quite a bit of expense to the patient, and it wasn't clear, although it was one of the agenda items, how patients are paying for this and how much they're paying. It's great technology, but it's very hard for a non-industry consultant ophthalmologist to get the true picture of how much of the cost might be offset by consulting fees. I don't know why we can't talk about that."

   Dr. Aker agreed with Dr. Katzen. In response, ASCRS legal counsel Rob Portman noted that medical societies like ASCRS need to be very cautious about discussing fees charged to patients or prices paid for new technologies in their educational meetings and webinars. According to Mr. Portman, "Medical societies and their members put themselves at risk of scrutiny under federal antitrust laws if they discuss (or facilitate discussions about) amounts physicians charge patients for specific services and that they pay for goods and services from suppliers. These issues can be addressed through carefully constructed surveys that meet federal requirements, but ad hoc discussions are risky." He added that he is waiting for more data to bolster the femto approach.

   "Perhaps beyond the knowledge of the presenters is the question of whether the lines for femto cataract will remain and lengthen, or will they go away because we can't demonstrate that 'real' advantage over our traditional approach," he said. "Enhanced precision would add significantly to the safety and reproducibility of the younger and less experienced surgeons who might still be challenged by making a consistent, round capsulorhexis. Unfortunately, these surgeons are typically not capable of making such a considerable capital purchase." Dr. Katzen said he was interested to hear surgeons who are using the laser talk about their successes, as well as their complications. "It was interesting to learn that those complications not related to the femtosecond portion of the cataract surgery are still occurring, specifically anterior vitrectomy and anterior capsular tears," he said. "We don't know at what rate they are [occurring], and I know that there's a learning curve. Having said all of that, I'd still love to have access to it. I think it will be a lot of fun to use. There will be some incremental benefit, it's just a question of how much incremental benefit." All three surgeons said they would continue to follow news about femtosecond laser-assisted cataract surgery, including any upcoming webinars. These are "interesting questions regarding a truly fascinating and exciting new technology making its debut in a very unsettled economic environment," Dr. Aker said. For the complete webinar, go to www.eyeworld.org/replay.php.


Editors note: Drs. Aker, Jenkins, and Katzen have no financial interest related to the topics discussed in this article.

No financial support was received to produce the femtosecond webinar series, and the program topics were developed based on questions received from members. Dr. Cionni has financial interests with Alcon (Fort Worth, Texas). Dr. Donnenfeld has financial interests with Alcon, Abbott Medical Optics (AMO, Santa Ana, Calif.), and LenSx (Aliso Viejo, Calif.). Dr. Fishkind has financial interests with AMO and LensAR (Winter Park, Fla.). Dr. Lane has financial interests with Alcon. Dr. Solomon has financial interests with LensAR. Dr. Vukich has financial interests with AMO.

Contact information

Aker: 561-886-1024, akeraba@gmail.com

Jenkins: 808-591-9911, tyrielee@gmail.com

Katzen: 561-732-8005, katzenlaser@aol.com