Eyeworld

EW FEATURE 31 just to break even, then don't fool yourself into thinking it's going to work for you," he warned. In his cal- culations, which are based on his own center's costs and pricing struc- tures, he believes practices need to perform a minimum of about 1,500 cataract procedures a year to justify the costs associated with the laser and still be profitable. And of those cataract cases, about 35%-40% would need to opt for a femtosecond laser procedure. Dr. Donnenfeld determined that of the 9,000 cataract surgeries Island Eye Surgicenter performs a year, "about 1,000" would need to opt for the femtosecond laser aspect to maintain an appropriate fee, he said. "Any surgery center that does more than 2,500 cases a year should be able to maintain a viable refrac- tive cataract practice, assuming a 20% penetration rate," he said. The Eye Institute of Utah found about 35% of its cataract patients opt for elective IOLs, and histori- cally, "about 75% of those require astigmatic reduction combined with the primary surgery, or as an en- hancement, to achieve the desired result. These patients would likely elect to have the laser procedure to achieve the astigmatic reduction," Dr. Cionni said, adding, "Thus far, about 25% of our conventional IOL patients are also opting for astig- matic reduction using the femtosec- ond laser." Location of the laser Where to physically place the laser must be considered as well. Dr. Donnenfeld said the "optimal place" to position the laser is outside oper- ating rooms, but nearby "so a sur- geon can perform the femto laser portion of the surgery and then send the patient into the operating room to ensure all the operating rooms in the surgical center can be maximally utilized," he said. At Island Eye Sur- gicenter, the optimal space is still being identified after having toyed with the idea of the laser on a differ- ent floor than the OR. Dr. Cionni recommended "addi- tional space within the ASC firewall or just outside the ASC firewall" for laser placement. "Since we currently recommend leaving the patient in the bed or chair until the cataract procedure is completed, it is best to have the laser near the operating room," he said. Putting the laser in one dedi- cated room limits use of that room, Dr. Donnenfeld said. "It restricts a patient's accessibility to the laser and will cause delays in patient turnover time." Personnel Incorporating new technologies often means hiring additional staff or training current staff. As far as educating patients on the technology, Dr. Cionni presents the femto option himself or uses his elective IOL/refractive coordinator. "Like premium IOLs, the coordina- tor had to be trained on how to speak about the laser, with some of our preferred key words being preci- sion, accuracy, less variability, ad- vanced technology, etc." If a practice already employs someone to run the excimer laser, the same person could be easily trained to run the femtosecond re- fractive cataract laser, he said. Femto's future Dr. Cionni predicts the technology is here to stay. "A big determinant for how quickly and how successful it's going to be will hinge on the num- ber of patients that require and are willing to undergo astigmatic reduc- tion to attain their desired refractive outcome," he said. Dr. Donnenfeld said his group has learned some valuable lessons over the past month: "Occasionally, patients' pupils do come down, so now we often give intracameral epi- nephrine when we start the cataract extraction. In addition, you can't give lidocaine gel before surgery be- cause it interferes with the suction needed to allow the use of the fem- tosecond laser. Also, certain patients aren't ideal because of the size of the interpalpebral fissure or their ability to fixate and not move during the surgical case," he said. Anecdotally, he's heard of some February 2011 July 2011 Laser-assisted cataract surgery Poll Size: 1047 EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a monthly reader pulse on trends and patterns for the practicing ophthalmologist. Each month we send a short 4-6 question online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the current 1,000+ physicians who take a minute a month to share their views, please send us an email and we will add your name. Email: ksalerni@eyeworld.org and put EW Pulse in the subject line; that's all it takes. Copyright EyeWorld 2011 continued on page 32 International point of view Makati City, Philippines I n the Philippines, physicians first eval- uate new technologies and then the business team evaluates the technol- ogy "for viability and benefits to the practice," said Harvey S. Uy, M.D., director for research at the Asian Eye Institute, Makati City, Philippines. The technologies that gain approval of both stakeholders are then purchased, he said. In his country, de- vices are registered rather easily, provided they already have a Eu- ropean or U.S. approval, he said. A country known for its "medical tourism," the average cost per eye for phaco (before adding on ad- ditional fees for the femtosecond laser) in private hospitals in the Philippines has been cited as ranging from $1,000 to $2,500 (for premium IOLs). Dr. Uy said practices might want to consider hiring a dedicated laser operator "if surgeons do not want to perform the laser portion themselves and just want to do the phaco portions." At his practice, two phaco surgeons alternate with one another on the femto laser system. In Dr. Uy's opinion, any marketing campaign that a practice undertakes "should highlight the high-tech nature of the femtolaser and its inherent surgical benefits," he said. In his opinion, the technology brings "several potential advantages" to the table. Included in the potential advantages, Dr. Uy identified: "preci- sion, efficiency, safety, and improved refractive results."

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