Eyeworld

EW FEATURE 48 Femto cataract clinical update July 2015 AT A GLANCE • One major barrier to the adoption of the femtosecond laser for cataract surgery is cost. Many patients must pay out of pocket for the technology, and in Ireland, the lack of insurance coverage has so far prevented the technology from being used. • Advantages of using the femto laser are that less phaco energy is used, and the laser can make consistently rounder capsulorhexes, according to surgeons. • Although the benefits over standard phaco are not necessarily clearly defined in routine cases, the femtosecond laser can be particularly beneficial for complicated cataracts. by Ellen Stodola EyeWorld Staff Writer practicable experience through their training program, and I think this is a shame but is a pattern that is mirrored around the world." Reimbursement of FLACS In Australia, there is no reim- bursement for the laser portion of femtosecond surgery, Dr. Lawless said. "There has been a pattern of copayment for many years so that if a patient wishes to have cataract surgery performed privately, part of the surgical fee comes from the fed- eral government system [Medicare] and part of it is paid by the patient's health insurance, and the patient tops up the rest," he said. Because patients have been used to a copay- ment system, when they go private- ly for surgery, the LenSx (Alcon, Forth Worth, Texas) is one more copayment, so it is not an unfamil- iar setting for patients, he said. In Singapore, Dr. Yeoh said, patients pay for the use of the fem- tosecond laser on their own, and he ond laser for other procedures, like femtosecond LASIK and for intra- stromal pockets and some corneal rings, the lack of insurance coverage and the ability to copay are the real obstacles in the adoption of femto- second laser-assisted cataract surgery in Ireland, he said. Specific challenges in different countries Dr. Yeoh said that the biggest chal- lenge is the cost of purchase and the "click" fee, which he said makes the surgery 25% more expensive than standard phaco. Dr. Lawless said he sees no specific challenges with the femto- second laser. "Really the only challenge is ready access to the technology and having the technology in place in a hospital or day surgery center that you routinely operate," he said. "There are no installations in major teaching hospitals so ophthalmol- ogy trainees [registrars] do not gain Lawless said, after 2013, the number of installations stopped and did not expand in the way that he thought they would. "Back in 2011, I thought there would be a slow up-take but then it would build momentum so that it became a very commonly performed procedure," he said. "Within Aus- tralia approximately 6% of cataract and refractive lens procedures are performed with the femtosecond la- ser, and this mirrors very closely the percentage of multifocal lenses used within the country as well." In Dr. Lawless' personal practice, he has been using the femtosecond laser for the majority of his cataract cases since 2011. "Currently I use it in 95% of cases, and the 5% where it is not used are mainly financial im- pediments or less commonly tech- nical reasons," he said. Additionally, he thinks that in certain cases, like with Fuchs' dystrophy, pseudoexfoli- ation, or white cataracts, it provides a clear advantage in safety. "I think this increase in safety for an individual patient applies across the spectrum of cataract and lens surgery, so for that reason I offer it to everybody." Meanwhile, femtosecond laser- assisted cataract surgery (FLACS) ar- rived in Singapore in 2012, Dr. Yeoh said, with 2 machines purchased and placed in private hospitals and 2 additional purchased and placed in institutions. "Interestingly, the volume of FLACS has been significantly higher in institutional practice than in pri- vate," he said. "I ascribe this trend to the presence of more cutting-edge cataract surgeons in the institutions than in the private sector." Some of the private surgeons are reluctant to learn and embrace a new, expensive procedure that has not yet been proven superior. "I have practices that straddle both these sectors and perform FLACS at each location equally, as I believe the technology yields better results," Dr. Yeoh said. In Ireland, however, the fem- tosecond laser is not yet being used for cataract surgery. Dr. Cummings attributed this to insurance compa- nies because currently the laser is not a covered procedure and copayments are not permitted. Although he is using the femtosec- Femtosecond laser experiences around the world Surgeons in different countries share their experiences adopting the femtosecond laser into practice T he experience of incorpo- rating the femtosecond laser for cataract surgery into practice has been dif- ferent for surgeons around the world. Michael Lawless, MD, clinical associate professor, Univer- sity of Sydney, and ophthalmic sur- geon, Vision Eye Institute, Sydney, Australia; Arthur Cummings, MD, Wellington Eye Clinic and Bea- con Hospital, Dublin, Ireland; and Ronald Yeoh, MD, consultant eye surgeon and medical director, Eye & Retina Surgeons, Singapore, spoke about the introduction and adop- tion of femtosecond laser cataract surgery in their experience. Adoption of femto Dr. Lawless was the first surgeon to introduce the femtosecond laser to Australia in April 2011. "In the first 2 years, the number of femtosec- ond lasers available increased more quickly than I would have antici- pated so that there were more than 20 units installed, allowing access to the technology in almost all major cities," he said. However, Dr. A round and centered femtosecond laser-created capsulorhexis with a nicely positioned implant is the main reason for FLACS success, according to Dr. Yeoh. Source: Ronald Yeoh, MD

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