JUN 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 5 of 74

June 2013 Femtosecond lasers for cataract surgery gaining ground, survey shows www.AcrySofReSTOR.com by Michelle Dalton EyeWorld Contributing Writer Higher volume surgeons can pay off the devices in less than five years P hysicians are using tiered approaches to pricing with the femtosecond laser for cataract surgery, which has helped increase patient interest, according to a new survey. The 2013 Femtosecond Laser Usage in Cataract Surgery survey, conducted by SM2 Strategic (Pleasanton, Calif.), was completed in March, after distribution to the 134 U.S. centers with femtosecond lasers for cataract surgery installed by the end of 2012. Sixty-five centers, used by 205 surgeons, responded, a 48.5% response rate. Respondents had their lasers in place on average 12 months (with a range of 2-27 months), and surgeons using the laser performed 660 cataract procedures a year, with 22% of eyes receiving premium IOLs, said Shareef Mahdavi, president, SM2 Strategic. Overall, toric and presbyopia-correcting lenses have remained stable since 2011, with about 8.8% and 12.9% penetration rates, respectively. In the survey sample, there were a total of 37,670 laser procedures performed that generated $32.4 million in incremental fees, Mr. Mahdavi noted. In the first quarter of 2013, of the procedures performed with the femtosecond lasers for cataract surgery, 50% were with a conventional IOL, 17% were with a toric IOL, and 33% were with a presbyopic IOL. "There weren't any major surprises," he said. "The penetration rate happens quickly in a practice and then trends to just north of 30%, which is about what we saw last year." What was a surprise, he said, was that "even though the average fee went down a bit, the number of cases required to reach breakeven over a five-year period also declined (from 23 to 19 eyes per month)." The data from practices suggests that for physicians who are part of a group that is doing around 750 total cataract procedures a year, the cost of the femtosecond laser's return on investment will be recouped in five years, he said. A well-run practice that does 1,500 or 2,000 cataract cases per year can recoup their investment in 2-3 years, Mr. Mahdavi said. Tiered pricing According to the survey respondents, there is an average $859 change in fee for providing refractive services that include the femtosecond laser. The increased pass-along cost for patients choosing conventional lenses was $1,058, for those receiving toric lenses, $664, and for those receiving presbyopia-correcting lenses, $673. The demand for refractive cataract surgery has expanded with the advent of additional technologies, including the laser. It's not just about the type of lens going in the eye but all the services offered to help patients achieve their goals. Almost half the respondents believe having a femtosecond laser has increased the volume of procedures (44%), and has increased the use of premium IOLs in the practice (46%). "We asked for physicians' subjective impressions," Mr. Mahdavi said. "What it points out is that doctors believe their premium market is expanding, and the laser as well as intraoperative aberrometry is helping increase the appeal to consumers willing to pay for services beyond what's typically covered." continued on page 9 CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof® IQ ReSTOR® Posterior Chamber Intraocular Lens (IOL) is intended for primary implantation for the visual correction of aphakia secondary to removal of a cataractous lens in adult patients with and without presbyopia, who desire near, intermediate and distance vision with increased spectacle independence. The lens is intended to be placed in the capsular bag. WARNING/PRECAUTION: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Physicians should target emmetropia, and ensure that IOL centration is achieved. Care should be taken to remove viscoelastic from the eye at the close of surgery. Some patients may experience visual disturbances and/or discomfort due to multifocality, especially under dim light conditions. Clinical studies with the AcrySof® ReSTOR® lens indicated that posterior capsule opacification (PCO), when present, developed earlier into clinically significant PCO. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon for this product informing them of possible risks and benefits associated with the AcrySof® IQ ReSTOR® IOLs. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® Natural IOL and normal color vision. The effect on vision of the AcrySof® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS® or BSS PLUS® Sterile Intraocular Irrigating Solutions. ATTENTION: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions. The top slide shows the percentage of all cataract procedures using the laser in the first quarter of 2013. At bottom, we see that based on actual usage, physicians need to perform about 19 cases per month to break even on the cost of the laser. Source (all): SM2 Strategic © 2013 Novartis 1/13 RES12192JAD

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