Eyeworld

EW CORNEA December 2011 29 was primarily examined in this paper was PK, but we and others have also demonstrated the use of the laser in lamellar keratoplasty techniques." Femtosecond lasers are being used for a variety of other corneal surgeries including limbal relaxing incisions, wedge resection, and even cataract incisions. "I think the real potential is that eventually the software and hardware of fem- tosecond lasers is going to allow for even more sophisticated designs of corneal cuts that will hopefully elim- inate the need for sutures." Dr. Steinert thinks that use of the FLAK procedure will enable prac- titioners to fine-tune the surgery with LASIK. "Because we have confi- dence in the incision and our ability to get the sutures out earlier, we are more often in a position to be able to offer a secondary procedure to pa- tients," he said. "They have the transplant that heals, they get the sutures out, and then they have LASIK to reduce the amount of opti- cal correction that they would need in glasses and to improve the quality of their vision." Cost remains a factor, with the laser itself running in the neighbor- hood of $300,000. While many al- ready have the laser to perform the FLAK procedure, those with older versions need a $50,000 upgrade. Dr. Chamberlain said that there's also a click fee of about $300 for cutting the patient's cornea as well as one for the donor cornea prepared at the eye bank. "Insurance will pick up the fee that the eye bank charges but will not pick up the cost that the surgeon has to incur cutting the pa- tient's cornea in the operating suite prior to surgery," Dr. Chamberlain said. "Currently the problem with that is Medicare doesn't reimburse." As a result, the surgery center usu- ally ends up absorbing the extra cost, although in a few rare in- stances this is passed on to the pa- tient. Overall, Dr. Chamberlain sees the femtosecond laser as potentially making the FLAK procedure safer. "This is probably a first step in al- lowing us to explore more sophisti- cated ways to make incisions in corneas, ways that will cut down on the requirement for sutures, which are a major risk factor for astigma- tism and wound complications," he said. "Ultimately I think that the femtosecond laser is going to lead to a safer outcome and probably an earlier visual recovery after corneal transplant surgery." EW Editors' note: Dr. Chamberlain has no financial interests related to this article. Dr. Steinert has financial interests with Abbott Medical Optics (Santa Ana, Calif.). Contact information Chamberlain: 503-475-7587, chamberw@ohsu.edu Steinert: 949-824-0327, steinert@uci.edu 888.905.7 or v Call EYME S YS ODYS 0 7 7 888.905.7 online. visit us M O D.C EYME 2975 Brother Blvd | Bartlett TN 38133 *Certain conditions apply 2975 Brother Blvd | Bartlett TN 38133 . *Certain conditions apply

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