Eyeworld

EW FEATURE 37 gery in early May. "I believe the in- creased accuracy of the procedure, the accuracy of the capsulorhexis, the accuracy of the corneal incisions producing reliable and reproducible corneal cylinder, and the ability to perform incisions to treat pre-exist- ing astigmatism give me the ability to give patients a refractive outcome that is superior to that which is ob- tainable with conventional cataract surgery and manual LRIs." Dr. Donnenfeld said he models his system after the one established for premium IOLs. "The reimbursement issue re- volves around the patient's desire for a refractive outcome," Dr. Donnenfeld said. "Patients have to acknowledge and request that they are interested in seeing without glasses for distance, seeing without glasses for reading, or both. If they desire this refractive outcome, I can offer them a procedure that in- creases the likelihood that they will achieve their desired outcome, and that allows me to charge for the pro- cedure." Dr. Donnenfeld said his patients are signing an informed consent, and the options are laid out for them. "One of the options that is available to them is to have laser re- fractive cataract surgery to reduce their dependence on glasses, and we're charging patients for the extra testing and the procedure that goes along with it, as well as the follow- up care," he said. "We are comfort- able treating and charging patients with pre-existing astigmatism or those receiving refractive IOLs. The gray area is patients who are not in the previous two groups." But Ms. McCann said charging more for cataract surgery with the femtosecond laser without perform- ing laser corneal incisions is prob- lematic and could lead to trouble down the road. "Minimizing post-operative ametropias is inherently part of proper biometry and the planning of cataract surgery. Those are covered procedures," Mr. Corcoran said. "Surgeons can charge, with ap- propriate patient consent, for fem- tosecond corneal relaxing incisions to treat pre-existing astigmatism. Approximately one third of cataract patients have clinically significant corneal astigmatism (>0.75D) that would merit refractive surgery. The remaining patients have little or no astigmatism, so for those patients a charge for refractive surgery is not seriously contemplated," Mr. Corcoran said. Robert J. Cionni, M.D., Salt Lake City, said he has set the bar for astig- matic reduction at 0.75 D, which means 35-45% of his patients can be treated with the laser for astigmatism. February 2011 July 2011 Laser-assisted cataract surgery continued on page 38

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