May 2016




Presentation spotlight

How femtosecond laser technology could fit into a practice

by Ellen Stodola EyeWorld Senior Staff Writer

Dr. performs femtosecond surgery

Dr. Tsai performs femtosecond laser-assisted cataract surgery.

Source: Linda Tsai, MD

When deciding whether or not to use femtosecond laser technology, its important for a surgeon to consider how it will fit into his or her practice. During the 2016 Asia-Pacific Academy of Ophthalmology (APAO) meeting in Taipei, Taiwan, Linda Tsai, MD, St. Louis, discussed this topic, looking at it specifically from the U.S. practice perspective.

In the U.S., surgeons can present femtosecond laser options to the patient in combination with refractive IOLs. So if patients elect a premium IOL or astigmatism correction, they will agree to pay extra for this procedure, she said.

The question on everyones mind is: What is the future of the femtosecond laser? Many physicians worry that they will spend a lot of time and money without knowing whether this new technology will become obsolete, Dr. Tsai said.

Should physicians incorporate femtosecond cataract surgery into their practice? There are both pros and cons to consider. Pros include that its widespread in multiple countries. An important factor is that in the U.S., the next generation of surgeons is learning it; it is seen in a lot of residency programs, she said. The laser helps with complex surgery and offers improved refractive outcomes. There are cons as well, including difficulty with access to the technology; the cost, time, and learning curve of using the new technology; cost effectiveness; and potential procedure complications.

I do think there are refractive benefits, Dr. Tsai said. Everyone wants better refractive outcomes, and the femtosecond laser offers the ability to perform a more precise capsulotomy and more precise arcuate incisions with less total ultrasound energy, she said. The take-home message is that femtosecond laser-assisted cataract surgery is not better than standard phaco long term, she said, but there may be some short-term improvements in vision at this time.

There is also the possibility for improved safety, but these procedures are not complication-free, Dr. Tsai said. However, she noted that there is a definite increase in safety for certain clinical scenarios.

When surgeons are deciding whether or not to incorporate the femtosecond laser into their practice, Dr. Tsai said that personal beliefs also matter. Do you believe in the potential benefits? Incorporation of this technology is where future potential and growth in cataract surgery will occur, she said. Costs will improve, but there will always be an issue because the expense is out of pocket, Dr. Tsai said. When using this technology, the physician should be the one to present the option to the patient, Dr. Tsai said. Show that the practice offers cutting-edge technology, she recommended. All patients should be educated about additional refractive options, and patients with complex cases should be told about options that may make the surgery safer. Dr. Tsai stressed that she only goes into detail about the procedure with good candidates who are interested after knowing the costs. I dont want my patients who decide to do standard phaco to feel like they are getting inferior treatment, she said. Femtosecond cataract surgery is not for every patient. Be sure to select the right patients; they should feel that the surgeon is customizing their surgery options. If they say yes, I think you should proceed as if it is a cosmetic procedure, Dr. Tsai said. Be sure the patient understands that there are no guarantees. Even if the patient wants to move forward with using the femtosecond laser, the surgeon still needs to consider if the patient is a good candidate and may have to change the patients mind, based on clinical decision-making. Dont be afraid to say no, Dr. Tsai said. What is the surgeon ultimately trying to accomplish? Dr. Tsai said that improved refractive outcomes, improved patient safety, and economics all factor in. And definitely, you want to under-promise and over-deliver, she said.

Editors note: Dr. Tsai has no financial interests related to her comments.

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