Eyeworld

EW FEATURE 32 by Enette Ngoei EyeWorld Contributing Editor The next wave: How we're making it happen today Experts discuss the best business models for prac- tices that want to invest in the femtosecond laser for cataract surgery I t makes reproducible incisions in the eye, which is good for corneal incisions, good for the capsulorhexis, and good for cataract surgery, said Richard J. Mackool, M.D., director, Mackool Eye Institute, Astoria, N.Y., dis- cussing some of the potential bene- fits of the femtosecond laser for cataract patients. "You also decrease chances of producing stress on the zonule be- cause the nucleus has already been essentially divided, so there'll be much less manipulation required to divide the nucleus. For patients who have relatively poor endothelial cell counts, there will be less ultrasonic energy required inside the eye, less fluid flow to the eye, so that the overall trauma of the procedure will be reduced, " he said. Anything that can perform all that is here to stay, Dr. Mackool said, it's just a question of how fast it penetrates the market. There are high costs associated with the purchase, usage, and main- tenance of the equipment, as well as logistical factors that will affect workflow. Therefore, a good business model is required if a practice is to integrate the technology success- fully. Different workflow and logistics Unlike previous technologies such as the excimer laser where a practice would buy the technology, in this case, it would be a surgical facility— be it hospital-based or ambulatory surgery center (ASC)-based—that would purchase the femtosecond laser, said Kerry D. Solomon, M.D., director, Carolina Eyecare Research Institute, Carolina Eyecare Physi- cians, Charleston, S.C. Practices that are already geared for elective surgery, like premium lens implantation, are going to be ideally suited to integrate this tech- nology, Dr. Solomon said. He explained, "There's a whole transition that needs to occur from the traditional insurance-based prac- tice of medicine to more of an elec- tive-based practice where staff— from the people at the front desk to the technicians—need to be com- fortable discussing options and physicians need to be comfortable discussing options, helping to de- velop or recommend the right sort of technology to the right patient." Practices that have already tran- sitioned to a more elective-based practice understand how to separate these types of visits—whether they're insurance-based or looking for elective surgery—and how to make sure questions get answered. They already have the educational material to provide the patients, they're already involved with things like social media, and they have ac- tive websites. They have financing options and they have surgical coor- dinators, so they're already geared up for this. When it comes to inte- grating laser-assisted cataract surgery technology, it's going to be an easy transition for them, Dr. Solomon said. But that's not to say that the tra- ditional insurance-based practices couldn't also integrate this, he added. Another aspect to consider when adopting the technology is that there will be two parts to the cataract procedure. Stephen G. Slade, M.D., direc- tor, Laser Center of Houston, and medical director of Alcon's LenSX unit, explained, "You're still taking the patient into the OR and doing the traditional phaco, but now you're doing this other step where you're taking the patient up to the laser before that and using the laser, so of course all of that is additional time." February 2011 Laser-assisted cataract surgery July 2011 Bringing continued from page 31 physicians who perform the laser portions at one facility and have patients driven to a second fa- cility for the cataract extraction/IOL implantation. "I cannot state strongly enough that this is not the optimal way to perform the surgery," he said. "The added time will result in additional inflammation and it reduces the pre- mium experience for the patient." For now, the femtosecond re- fractive cataract laser "remains a work in progress," Dr. Donnenfeld said. "We're dedicated to finding the right solution that combines a posi- tive patient experience, good patient flow, and superb visual results." EW Editors' note: Dr. Cionni has financial interests with Alcon (Fort Worth, Texas). Dr. Donnenfeld has financial interests with Abbott Medical Optics (Santa Ana, Calif.) and Alcon. Dr. Uy has financial interests with LensAR (Winter Park, Fla.). Contact information Cionni: 801-266-2283, rcionni@theeyeinstitute.com Donnenfeld: 516-446-3525, eddoph@aol.com Uy: +011 632 898-2020, harveyuy@yahoo.com AT A GLANCE • Unlike previous technologies such as the excimer laser where a prac- tice would buy the technology, in this case, it would be a surgical fa- cility, be it hospital-based or ambu- latory surgery center (ASC)-based, that would purchase the femtosec- ond laser • Practices that are already geared for elective surgery, like premium lens implantation, are going to be ideally suited to integrate this tech- nology • You're still taking the patient into the OR and doing the traditional phaco, but now you're doing this other step where you're taking the patient up to the laser before so all of that is additional time. Eventually, the femtosecond portion of the pro- cedure will be performed by a physician other than the phaco sur- geon before the patient heads into the OR • Dr. Slade thinks the best business model is to have a high percentage of premium IOL patients and to be dealing with a lot of astigmatism, in other words, a refractive cataract practice With the femtosecond laser, the capsulorhexis can be placed precisely where the surgeon wants Source: William W. Culbertson, M.D. Aspiration alone can remove the cataract from the bag Source: William W. Culbertson, M.D.

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