EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/387844
EW FEATURE 84 Complex cataract cases October 2014 by Michelle Dalton EyeWorld Contributing Writer Geographic differences persist in femto practice patterns, and usage corneal tissue requires the most precise spot placement." Cost may be a hurdle (for now) The cost of using these lasers in surgical practices—both the cost of obtaining the technology and reimbursements for implementing them in practice—was the most- often selected concern about their use, according to 61.7% of respon- dents (see Figure 2). However, even given these concerns, 92% of respondents to the 2014 ASCRS Clinical Survey plan to be performing LACS in 10 years, and about a third believe it will be on the majority of their cataract procedures, showing high optimism for the technology. The results likely do "accurate- ly represent the general sentiment about femtosecond lasers in both the U.S. and abroad," Dr. Henderson said. Physicians see clinical benefits but those outside the U.S. are much more cautious in their approach to the technology W orldwide, most surgeons believe femtosecond laser cataract surgery may provide a significant clinical benefit versus conventio - al cataract surgery in the areas of arcuate refractive incisions (59.3%), capsulorhexis creation (58.8%), and lens fragmentation (52.1%), accord- ing to results from the 2014 ASCRS Clinical Survey. U.S. respondents believe more strongly the technol- ogy may provide a more significant benefit compared to non-U.S. r - spondents (see Figure 1). The biggest difference (and the only variable to reach statistical significance) in U.S. benefit of astigmatism control using the laser." The "jury is still out on the clin- ical benefits," D . Berdahl said. "You can't get to evidence-based medicine without first being able to accum - late the evidence. We're still in the accumulation of evidence phase of this technology, but those of us who use it on a daily and regular basis feel it does have a true clinical benefit. Dr. Berdahl said since he has begun using the technology, he thinks the lens fragmentation aspect is one of the most important. "The ability to fragment the cataract for removal may or may not help with refractive outcomes, but it does help me do a better cataract surgery with less energy, a little bit quicker and in a more controlled way; however, the quality of corneal incisions is probably the greatest stress test for the quality of femto- second laser platforms since the and non-U.S. respondents was in arcuate refractive incisions. One reason for the discrepancy across borders is the financial lan - scape of the U.S. and what can be billed for reimbursement and what cannot, said John Berdahl, MD, in private practice, Vance Thompson Vision, Sioux Falls, S.D. "Some of the differences that are seen between U.S. and non- U.S. surgeons in their perception of the efficacy of a cuate incisions have to do with the reimbursement rules in the U.S.," said Bonnie An Henderson, MD, clinical professor of ophthalmology, Tufts University School of Medicine, Waltham, Mass. "Since the current reimbursement for the use of the femtosecond laser in cataract surgery has been tied to the correction of astigmatism with arcuate incisions, more emphasis has been placed on studying this factor in the U.S. Therefore, U.S. surgeons may be more aware of the 2014 ASCRS Clinical Survey Figure 2: If you are not performing femtosecond laser-assisted cataract surgery, what are the barriers to your adoption of the technology? Source (all): 2014 ASCRS Clinical Survey Figure 1: In which of the following clinical areas do you believe laser cataract surgery may provide a significant clinical benefit versus conventional cat act surgery? (Select all that apply.) Arcuate refractive incisions Self-sealing corneal incisions I don't believe this will offer a significant clinical benefit in any of these areas Not enough data proving clinical benefit Interference with patient flo , additional time, and efficiency reduction Reimbursement/financial concerns No access to technology in my practice or an open access center I would consider Other Capsulorhexis creation Lens fragmentation