Eyeworld

EW FEATURE 38 by Ellen Stodola EyeWorld Staff Writer Global reception of femtosecond laser cataract surgery The new technology is being used differently around the world T he reception and utilization of the femtosecond laser in cataract surgery has been different around the world, depending on a number of factors. Jorge Alió, MD, PhD, med- ical director of VISSUM, Alicante, Spain; Burkhard Dick, MD, chairman, University Eye Hospital, Bochum, Germany; Michael Lawless, MD, Vision Eye Institute, and clinical associate professor, Sydney Medical School, Australia; Sheraz Daya, MD, FACP, FACS, FRCS(Ed), FRCOphth, chairman and medical director, Centre for Sight, London; and Peter Barry, FRCS, head of the Department of Ophthalmology, St. Vincent's Uni- versity Hospital, and senior retinal surgeon, Royal Victoria Eye and Ear Hospital, Dublin, discussed the topic of femtosecond cataract surgery and implementation in their countries. Adoption in various countries Dr. Alió said that the adoption of femtosecond cataract surgery in his area has been minimal. "There is only one device and patients are not particularly attracted by the technology," he said. "Promotion has not been important because the patients have found it difficult to understand the benefits of this technology and are especially sensitive to the high cost involved." Dr. Dick said that the use of the femtosecond laser in cataract surgery has rapidly expanded in Germany. Since December 2011, he has per- formed more than 2,900 femtosec- ond cases on a commercial basis. "Adoption of [femtosecond] cataract surgery has had a slow start in the U.K.," Dr. Daya said, with the first few lasers installed mainly in ophthalmologist-owned private ambulatory surgery centers from December 2011 to June 2012. "More lasers have since been installed in private centers with one corporate group recently acquiring 6 lasers for their institutions," he said. The first femtosecond laser cataract surgery in Australia was done in April 2011 by Dr. Lawless. The lasers are currently available in capital cities and some regional centers, in large private hospitals, as well as standalone ambulatory sur- gery centers. So far, the lasers are not in the public sector or teaching hos- pitals. Adoption has been relatively easy compared to other countries be- cause Australian patients are familiar with a co-payment system, he said. Limiting factors Dr. Lawless said some surgeons lack access to the laser because their ASC or hospital has not invested the cap- ital required to place the units, and some regional centers and small hos- pitals have low volumes of cataract surgery and cannot justify placing a device on financial grounds. "The limiting factor is money," he said, with patients paying anywhere from $300 to $1,000 extra for the technology. "One of the limitations I have observed is that surgeons will be trained on how to use the femtosec- ond laser and yet they will perform only occasional cases," he said. This makes it hard to get comfortable using the laser. Meanwhile, those who perform a significant percent- age of their cases with the femto laser become comfortable more quickly. Dr. Daya said the technology is highly desirable, but the cost is prohibitive for the majority of oph- thalmologists. "It is only the private sector that can afford the laser, and the challenge is justifying a higher cost to private patients," he said. "The main limiting factor is money followed by time dedicated to it," Dr. Alio said. He said that operating room time is increased, and it can require a second doctor to be involved in the procedures. Claims for use Dr. Daya said the majority of centers present femtosecond cataract sur- gery as a superior, more precise option that carries a premium price. "Claims of safety and precision are the main drivers," he said. "We have taken a different stance from others in that as a premium practice, we only provide premium surgery and therefore do femtosecond laser surgery on all cataract and RLE patients," he said. "We would not offer a procedure that we believed was 'less safe.'" "Femtosecond cataract surgery is presented as the most relevant innovation affecting the practice of cataract surgery at this moment," Dr. Alió said. "It is offered as an al- ternative to conventional surgery, as Refractive results of femtosecond laser cataract surgery June 2014 AT A GLANCE • Many surgeons agree that a major limiting factor with the femtosec- ond laser is the price, and a number of facilities have not yet acquired the technology for this reason. • Using the femtosecond laser is considered a premium procedure, which often comes with an added cost to either the surgeon or patient. • A study is currently being undertaken to compile data on consecutive femtosecond laser cases. T he topic of this Monthly Pulse survey was "Refractive results of femtosecond laser cataract surgery." We asked, "If you are not performing femtosecond laser assisted cataract surgery, what are the barriers to your adoption of the technology?" The majority of respondents said "Reimbursement/financial concerns," with "Not enough data proving clinical benefits," as the second most popular answer. When asked how confident they are that there is currently an adequate reimbursement solution (private pay and/or insurance) to support laser-assisted cataract surgery, "Not very confident" and "Not confident at all" were the top two answers. Arcuate refractive incisions is the area in which most respondents believe laser cataract surgery may provide a significant clinical benefit, followed by capsulorhexis creation. Finally, we asked, "Ten years from now, what do you believe will be your mix of laser vs. current hand-performed mechanical methods for creating incisions, rhexis and phaco for cataract patients?" Most respondents answered "Majority laser-assisted cataract surgery." Monthly Pulse Keeping a Pulse on Ophthalmology 32-41 Feature_EW June 2014-DL_Layout 1 6/3/14 12:31 PM Page 38

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