Eyeworld

EW REFRACTIVE 68 January 2019 Editors' note: Dr. Dell has financial in- terests with Bausch + Lomb (Bridgewa- ter, New Jersey) and Johnson & Johnson Vision (Santa Ana, California). Dr. Thompson has financial interests with Alcon (Fort Worth, Texas), Johnson & Johnson Vision, and Carl Zeiss Meditec (Jena, Germany). Dr. Vukich has finan- cial interests with Johnson & Johnson Vision. Dr. Williamson has financial interests with Alcon, Bausch + Lomb, and Johnson & Johnson Vision. Dr. Nehls, Dr. Waring, and Dr. Zaldivar have no financial interests related to their comments. Contact information Clinch: tclinch@edow.com Dell: steven@dellmd.com Nehls: nehls@wisc.edu Thompson: vance.thompson@vancethompsonvision.com Vukich: javukich@gmail.com Waring: gwaring@waringvision.com Williamson: blakewilliamson@weceye.com Zaldivar: zaldivarroger@gmail.com getting to that sweet spot where I am more comfortable, and that's because the platform I'm using includes the possibility to do flaps. I'm positively surprised with the flaps that I'm getting, and I'm using it with most of our flaps today. I'm using it in LASIK and phaco. I'm comfortable with the economics of this, and I think that's important. Dr. Dell: There are many physicians whose positions I respect who think that the femto clearly adds value in their hands, and in certain cases I can understand why that is the case. But if I envision a scenario where a patient had bilateral cataract surgery and it was done under general an- esthesia and both eyes got the same IOL, would the patient be able to tell a month postop which eye had been done with femto and which eye had not been done with femto? If you made that same comparison with a multifocal and a monofocal, the patient would know immediately. The value proposition to the patient is clear with a presbyopia correcting IOL, but with femto it's in the lap of the surgeon as to whether or not it makes the task more easily accom- plished. Dr. Clinch: We try to drive an outcome to our patient, whether it be distance acuity or a correction for reading or presbyopia. I live in Washington, D.C., which is a very technical part of the world and where people are very outcomes driven. I try to use all of the differ- ent technologies. I will use a laser on all of my patients. My thought is no matter what you do, you're not always going to have 100% success. For me, having used every modal- ity possible, I can look my patient in the eye and say I did everything possible to get you where you are. We've used advanced formulas, la- sers, intraoperative aberrometry, and the lens with the best optics for their visual life. To me, it's more of offer- ing a package of goods. Because we do a fairly high volume at our sur- gery center, it reaches a point where it's not super expensive, in the long term, to use the laser, because our center does between 2,000–3,000 per year. It has kept the cost economical for us to be able to do that and not have a huge incremental cost to using the laser. Dr. Williamson: We have a similar experience. We're a high-volume center and depending on how many cases you are doing with the femto- second laser, it can add tremendous value. Last year, we were up 25% in terms of our revenue from our cataract program, so it adds value monetarily. But I also think it adds value to the patient and to the surgeon. For the patient, I think the value is they see better quicker. Day 1 the vision is crisper than in my manual cases, but they have more of a 'wow' factor earlier. As to them un- derstanding the value, they equate the laser with precision. As much as we talk about it, as much contro- versy as there is, they have already decided they want that precision of the laser. My patients aren't OK with a less precise procedure even if it gives them safe, good outcomes. I think precision does matter. The value for the surgeon, for me, doing a lot of cases, is it's nice having a shooter system like what we use, to have half the case done before you get into the OR. It adds efficiency. People talk about efficiency and how femto slows you down. It does if you allow it to, but you can also use it to speed you up and add more cases per hour, and that's what we've been able to do by employing a second surgeon as a shooter. EW Does continued from page 66 Dr. Zaldivar Source (all): ASCRS Dr. Dell

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