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EW FEATURE 39 less depending on surgeon skills and more uniformly guaranteeing out- comes." Dr. Lawless said that in Australia, it is presented as a way that a surgeon prefers to perform the procedure, and the explanation often highlights safety and accuracy. "Most people emphasize the preci- sion and reproducibility of the laser compared to manual surgery, and this does seem to resonate with patients and referring optometrists," Dr. Lawless said. Dr. Dick said that femtosecond cataract surgery is presented as per- sonalized, individualized surgery with greater precision and accuracy. "We do not state that [femtosecond] surgery is safer," Dr. Dick said, but he does believe it to be safer. The technology shows good results for pediatric and infant cataracts, as well as "superb primary posterior capsulotomy," he said. Additional cost A factor to consider in femtosecond laser use is the increased cost, as it is considered a premium procedure and often comes with a price that is not covered by insurance. Dr. Dick said that in Germany, this extra cost is about €1,500 per eye (or about $2,089 U.S.), which is not covered by insurance. Dr. Alió said that femtosecond cataract surgery is considered a highly premium procedure, and currently the added cost is €800 per eye (or about $1,114 U.S.). "This is just to cover the cost as there is no revenue for the clinic or the doctor," he said. Australia features a co-payment system, so patients pay out of their own pocket, and the procedure is not covered by government or health funds, Dr. Lawless said. "Health funds and the government do contribute, however, to the cost of surgery as they would ordinarily," he said. Dr. Lawless added that the concept of premium surgery is not a significant factor in Australia be- cause surgeons mainly choose pre- mium options as they see fit for the patient. "They do not get paid more for doing these procedures, so they do what they think is best," he said. "Similarly, if patients have insur- ance, there is no extra financial bur- den with premium style lenses; it is a much truer situation where the surgeons and patients discuss what would be best for them and the sur- geon then selects the lens he/she thinks is most appropriate." Dr. Daya said that in his prac- tice, all patients undergoing cataract surgery or refractive lens ex- change get femtosecond laser tech- nology. "We increased our prices modestly and were able to do so as we could estimate more accurately the numbers of patients undergoing June 2014 Poll size: 185 EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send an online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the hundreds of physicians who take a minute a month to share their views, please send us an email and we will add your name. Email carly@eyeworld.org and put EW Pulse in the subject line—that's all it takes. Copyright EyeWorld 2014 Dr. Daya, using the VICTUS platform, is seen applying the suction ring to the patient's eye. continued on page 40 32-41 Feature_EW June 2014-DL_Layout 1 6/3/14 12:31 PM Page 39

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