Eyeworld

EW REFRACTIVE 66 January 2019 nology you choose to deliver that outcome should factor into it. Dr. Thompson: I educate patients on their vision options. We typically talk traditional cataract surgery and wearing bifocals vs. premium and restoring the reading range also. We talk about the distances they want to use their vision for, and we don't necessarily talk about the tech- nologies it takes to get there. I'm getting to know them and helping them with their vision decision, and whether or not I use a manual capsulotomy or an automated capsu- lotomy, Zepto (Mynosys Cellular Devices, Fremont, California), or femto, I'm using what I think is best to achieve that visual outcome for that situation. In my practice the use of femto technology has declined dramatically. For patients choosing presbyopia correcting implants the majority of my automated capsulo- tomies are now performed with the Zepto technology. Do you think the value of the femtosecond laser is there when you compare what it does to the price of what the system is? Dr. Zaldivar: I think that's the most critical question because the eco- nomics are tough with femtosecond platforms. Nowadays I'm finally of the technology that is available. Then there is a hybrid. If we could start the discussion with the ques- tion, "Is the femtosecond laser part of your patient education?" Dr. Williamson: With every single patient who comes in for a cataract evaluation, the last thing my tech- nician does before they leave the room is hand patients a tablet with a movie we made about the femtosec- ond laser that we use, with anima- tions and things like that, but also with each of our surgeons saying what they like about it. It's about 8 minutes long and very thorough. After that I come into the room and it makes the conversation easier. Dr. Zaldivar: If we consider this is better for the patient and we truly believe it, I will try to do it in all of my patients and don't give an option. My commitment is to do the best that I can with each patient. The patient pays exactly the same whether we are doing FLACS or not. Dr. Nehls: We predominantly focus patient education to promote the refractive lenses, and virtually all of the patients who have refractive lens surgery go on to have femtosec- ond laser-assisted surgery. We have some patients who are candidates for femtosecond surgery for smaller amounts of astigmatism and if they would benefit from an LRI then we bring up the laser technology. Our focus is not so much about the femtosecond assisted surgery; that seems to be more easily adopted and understood by the patients. It's more about the lens choices. Dr. Clinch: We think it's part of the comprehensive education process. We think every patient, regardless if they are going to have a refractive lens procedure or even if someone comes in with macular degenera- tion, should know all the options, so we try to start before the patient comes to our office. They are di- rected to our website to learn about cataract surgery. Then every patient is educated about femto as part of a refractive package, and we try not to dwell on safety as much as we use an acronym—GAP. It makes the surgery more gentle, accurate, and predict- able. We try to use that acronym be- cause we have five cataract surgeons and about 20 technicians, so one of the fears is not giving a consistent message among surgeons. Trying to have a consistent message and edu- cation on all processes is helpful. Dr. Vukich: Do you discuss the results and outcomes, expectations with your patients, and how do you fit femtosecond laser into that con- versation? What do you tell patients they might expect to gain as a result of choosing that modality? Dr. Waring: We take patients on a digital tour of their eye and explain how we have advanced options for cataract removal, and we do this in a gentle fashion with light, with lasers. Dr. Dell: I have a little different approach, which is I tend to stress visual outcomes entirely. Whatever technology I think I need to use to obtain that outcome, that's what I should be using. I think that if a patient opts for a presbyopia-cor- recting IOL but for some reason doesn't want the laser, that patient, in my mind, shouldn't be paying something different from a patient who does want it. If you think the laser, or a capsular dye, or some other technology is the best way to achieve your goals, you should incorporate those technologies in that particular case, and it should be independent of the finances. I've always been uncomfortable with this decoupling of results and technol- ogy. I think you should deliver an outcome. You ask the patient to compensate you for that outcome, and I don't think that the tech- Does continued from page 64 Dr. Waring continued on page 68 Dr. Vukich

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