Eyeworld

Step by step: Clinical and practical implementation of laser-assisted cataract surgery 2 In my experience, I have found that I can make much bet- ter corneal relaxing incisions with a femtosecond laser than with a diamond knife even though I per- formed diamond knife incisions for almost 30 years. When respondents were asked about the barriers to adoption of the technology, the number one obstacle was reimbursement/financial concerns (61.7%) (Figure 3). More than 32% reported a lack of access to the technology, and 35% believe data showing clinical benefits are lacking. Although large, high-volume cataract practices may be able to provide LACS on their own, a shared access model may provide options for many surgeons. Almost 60% of respondents are not confident that there is currently an adequate reimburse- ment solution (private pay and/or insurance) to support LACS today (Figure 4). In addition, almost 45% do not believe there is an adequate reimbursement solution to pay for LACS technology even 5 years from now. Experienced panel Based on educational gaps identi- fied in this survey, ASCRS has de- veloped programs to meet mem- bers' educational requirements. In this supplement, our panel of LACS experts will share clinical and practical recommendations for implementing this technology and achieving optimal surgical outcomes. Dr. Lindstrom is founder of and attending surgeon, Minnesota Eye Consultants, adjunct clinical professor emeritus, Department of Ophthalmology, University of Minnesota, associate director, Minnesota Lions Eye Bank, and visiting professor, University of California, Irvine, Gavin Herbert Eye Institute. He can be contacted at rllindstrom@mneye.com. Figure 1. When members were asked, "What percentage of your cataract patients receive femtosecond laser cataract surgery (currently)?" they reported that only 4.8% are receiving LACS. 0% 1 to 5% 6 to 10% 11 to 20% 21 to 50% 51 to 100% N/A U.S. 70.0% 65.0% 60.0% 55.0% 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Average U.S. 5.8% Non-U.S. 3.6% Overall 4.8% Non-U.S. Overall Figure 2. Responses to the question: "In which of the following clinical areas do you believe laser cataract surgery may provide a significant clinical benefit versus conventional cataract surgery (select all that apply)?" Arcuate refractive incisions Self-sealing corneal incisions Capsulorhexis creation Lens fragmentation I don't believe this will offer a significant clinical benefit in any of these areas 0% 10% 20% 30% 40% 50% 60% 70% 80% U.S. Non-U.S. Overall Figure 4. Respondents were asked how confident they are that there is currently an adequate reimbursement solution (private pay and/or insurance) to support laser-assisted cataract surgery (today). 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Extremely confident Confident Neutral Not very confident Not at all confident N/A U.S. Non-U.S. Overall Figure 3. Respondents answer the question: "If you are not performing femtosecond laser-assisted cataract surgery, what are the barriers to your adoption of the technology (select all that apply)?" 0% 10% 20% 30% 40% 50% 60% 70% Not enough data proving clinical benefits Interference with patient flow, additional time, and efficiency reductions Reimbursement/ financial concerns No access to technology in my practice or an open access center I would consider Other U.S. Non-U.S. Overall

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