EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/227001
February 2014 December 2013 What's ahead in2011 EW FEATURE 37 Will 2014 be the 'year of the laser'? by Michelle Dalton EyeWorld Contributing Writer Leading anterior segment surgeons seem to think so J ust a scant few years ago, the femtosecond laser was in its infancy with only a handful of surgeons investigating its uses beyond refractive surgery. Today, nary an anterior segment surgeon is unaware of the device's potential in both corneal and cataract surgery. When it comes to the femtosecond laser for refractive cataract surgery, "we wanted to get involved right away," said Mark Kontos, MD, in private practice, Empire Eye, Spokane, Wash., and Hayden, Idaho. The practice had a good relationship with Sightpath Medical (Bloomington, Minn.), and once the mobile ophthalmic service provider started offering a femto laser for cataract, Dr. Kontos immediately began using the service. "It's allowing us to use the LenSx [Alcon, Fort Worth, Texas] system and getting the experience many doctors are actively implementing these changes into their day-to-day routines.to develop the practice," he said. "What I like about the Sightpath model is that we can take baby steps in integrating the system into our practice without having to purchase the system outright right away." For Vance Thompson, MD, director of refractive surgery, Vance Thompson Vision, Sioux Falls, S.D., the laser is just part of the group's overall package offerings. "We market our refractive laser-assisted cataract surgery package as 'ReLACS,' and the laser is an integral part of it. Our laser-assisted cataract surgery includes incisions, capsulotomy, lens softening, and any astigmatic work in combination with intraoperative aberrometry for power documentation," Dr. Thompson said. Patients have "a lot" of confidence in a laser's capabilities, Dr. Thompson noted, and physicians know the laser can make incisions more precisely than the human hand. "Studies are now coming out to show that outcomes are better. The question others may still have is whether the improved outcomes are worth the price tag, and each practice needs to evaluate that for itself," he said. While the femtosecond laser may add a little more time to com- plete cases, the improved outcomes mean less postop chair time, said Robert P. Rivera, MD, director of clinical research, Hoopes Vision, Draper, Utah. "We recommend femto-phaco for patients who qualify as the best way to have cataract surgery performed today," Dr. Rivera said. The average case adds about three to four minutes to the overall procedure, but those few minutes "add so much benefit to the patient's visual outcomes that there's no question in my mind it's a worthwhile investment." He also uses the device on complex cataract cases, such as zonular dehiscence. No matter how good a surgeon is, "occasionally a patient moves Dr. Kontos positions a patient for femtosecond-assisted cataract surgery. AT A GLANCE • Patient awareness of the femto's capabilities may drive the market. • Femtosecond lasers will help produce better outcomes, but practices need to determine their own return on investment. and all of a sudden, a perfectly normal case isn't anymore," Dr. Kontos said. Surgeons are beginning to embrace the laser's ability to turn difficult cases into "more or less routine cases," he said, and cited white cataracts as one example. "Problems you can't get away from are now so much easier with the femto laser," he said. "It takes all the anxiety about these complicated cases away. Is that enough of an many doctors are actively implementing these changes into their day-to-day routines.argument to convince people they should have one or have access to one? Maybe." Dr. Thompson was such a believer in the technology that his new surgical center was designed around the laser. "We're not only working on a great patient experience, but from the moment cataract patients enter our atrium, it's a very choreographed sequence of steps that has us treating them more like refractive patients." His surgery center is somewhat circular in nature, so once patients sit in the chair, they are laid flat, moved to the femto, moved a few feet away for the rest of the Source: Mark Kontos, MD continued on page 38 Clinical continued from page 36 "This provides a coordinated effort for the consistency of societydirected education," Dr. Vukich said. How this changes education The first references to clinical value dossiers will likely emerge in some 2014 educational offerings from ASCRS. However, the hope is that the dossiers will work seamlessly over the long term. "In truth, a 'clinical value dossier' is a fancy name and is a for- malization of something educators have been doing all of their life," Dr. Stulting said. "Our membership benefits from the identification of relevant learning gaps and targeted educational efforts." Some of these specific educational gaps determined by the Clinical Committees will be the focus of several upcoming ASCRS meeting symposia, articles and sup- plements in EyeWorld and the Journal of Cataract & Refractive Surgery, and web seminars. The information shared by educators in these events and articles will not only make evidence-based arguments for why the educational gaps need to be resolved, but also provide clinical pearls and recommendations on how surgeons may go about addressing and resolving these gaps. Ultimately, the learning opportunities that will come from the value dossiers will help to benefit patients—and provide an uninhibited discussion of surgery, lasers, and lenses, Dr. Stulting added. EW Contact information Chang: 650-948-9123, dceye@earthlink.net Stulting: 770-255-3330, dstulting@woolfsoneye.com Vukich: 608-282-2020, javukich@gmail.com