March 2012





The femtosecond choice

by Enette Ngoei EyeWorld Contributing Editor

Femto cataract surgery

Dr. Desai performs femtosecond cataract surgery Source: Neel Desai, M.D.

Discussing the newly available option with patients

Now that you've decided to incorporate femtosecond cataract surgery into your practice, what's the best way to present this new option to your patients? EyeWorld talked to physicians in the U.S. and abroad who have worked it out.

When his practice first incorporated the LenSx Laser (Alcon, Fort Worth, Texas), Kerry D. Solomon, M.D., director, Carolina Eyecare Research Institute, Charleston, S.C., said he found it wasn't quite as simple a conversation as he thought it would be with patients.

"It got confusing between I'm going to use a presbyopia-correcting lens, now would you also like a laser used," he explained.

So he sat down with staff and educated them about the laser. Together, they reworked some of their patient education materials as well as how they talked to patients. Now, instead of talking about lens choices, laser versus ultrasound, and astigmatism versus no astigmatism, the discussion has been reoriented to focus on three options.

"Rather than giving patients all the options of what they want, I tell them what I'm going to recommend for them based on what their vision needs are or what their vision choice is, and that seems to work incredibly well. So it's really a very short conversation," Dr. Solomon said.

In option one, patients get a standard monofocal lens that insurance provides and are fitted for glasses for all their daily activities. In option two, their vision is corrected for distance and they'll use glasses for reading. In option three, patients would be able to see both distance and near without being dependent on glasses. "If they're already successful monovision patients, I tend to keep them in monovision and we'll treat their astigmatismif it exists. If they have never done monovision and they are multifocal candidates, then I discuss this option for their presbyopic needs. If they have astigmatism, we manage that in addition to the presbyopia, in my case, typically with a femtosecond laser," Dr. Solomon said. Neel Desai, M.D., in private practice, Largo, Fla., said, "We explain to patients that just like LASIK went through an evolution from conventional LASIK to all-laser LASIK, this is the next evolution in cataract surgery."

Dr. Desai said his practice is extremely careful not to suggest that femtosecond cataract surgery is any safer than the conventional way. That has yet to be born out in any kind of literature or study, and he and colleagues want to avoid being the kind of practice that plays on patients' fears of blades or scalpels in order to drive their adoption of this technology, he said.

"We simply explain the benefits in precision, especially for astigmatism correction, and other critical steps of the procedure over conventional methods," he said.

Dr. Desai tells patients that they have three basic decisions to make: when to do the surgery, how they want it done (either the conventional way or with the laser), and what range of vision they're looking for. "We're careful to describe things in terms of the investment they're making in the quality and range of vision by utilizing all available technologies, like the femto laser, intra-operative aberrometer, and advanced IOLs, in order to most accurately correct astigmatism and provide the greatest level of spectacle independence. Most patients intuitively understand this and instinctively choose this option if it fits their expectations and desires for post-operative results."

The conversion rate at his practice is at about 30%, he said.

Like Dr. Desai, Jerry Hu, M.D., in private practice, Fort Worth, Texas, also talks to patients about the two cataract surgery methods. He tells patients that in the traditional technique, the surgeon, who is well trained in the procedure, is going to be using handheld scalpels and it's proven to be a safe procedure. He also tells patients that in laser cataract surgery, the same laser that has been used for LASIK has been adapted to cataract surgery to treat astigmatism. He uses a computer to take real-time measurements of the eye and customizes a surgical treatment plan on the computer. When the plan is completed, a laser carries out the most critical parts of the surgery that will involve cutting in about 1 minute or less. He also adds that the laser can perform portions of the cataract procedure.

Dr. Hu, whose conversion rate is about 40%, said he groups the LenSx technology with lifestyle implants in his patient offerings.

Femtosecond abroad

Femto choice article summary

It is important to note that the guidelines for use and billing of the femtosecond laser in place in other countries may differ from U.S. guidelines. In Germany, Michael Knorz, M.D., professor of ophthalmology, Heidelberg University, Manheim, said he offers laser refractive lens surgery as his standard because he feels it's better than manual phacoemulsification.

"Of course I will explain to every patient that there is another choice, namely manual phacoemulsification, and I will give my reasons why I believe laser refractive lens surgery is better. But I typically will not offer a choice to the patient. My initial experience with this approach is quite good. Patients embraced the new technology readily," he said. In Australia, Michael Lawless, M.D., clinical senior lecturer, University of Sydney, also offers laser cataract surgery as his standard. "Every staff member from the time we began in April knew that we were introducing this technology because it has the potential to revolutionize how we do cataract surgery. We felt that the small amount of data in the published literature supported this, and my experience here in 2011 has assured me that this new technology has promise," he said.

He doesn't talk to the patients much about the laser side of the procedure; his clear message is that it's the way he prefers to do it as long as patients are suitable candidates for the procedure. His main discussion revolves around what type of intraocular lens would be best suited to the patient as well as the risks, benefits, and complications involved.

Editors' note: Drs. Desai, Knorz, Lawless, and Solomon have financial interests with Alcon. Dr. Hu has no financial interests related to this article.

Contact information

Desai: 727-518-2020,
Hu: 817-540-6060,
Lawless: 61-29-4249999,
Solomon: 843-792-8854,

Related articles:

Evaluation of dry eye after femtosecond laser-assisted cataract surgery: a prospective study

Ethics of femtosecond laser-assisted cataract surgery by Ellen Stodola EyeWorld Staff Writer

Review of Femtosecond laser-assisted compared to standard cataract surgery for removal of advanced cataracts

Can femtosecond lasers live up to the hype? by Michelle Dalton EyeWorld Contributing Writer

Assessing femto-assisted astigmatism by Vanessa Caceres EyeWorld Contributing Writer

The femtosecond choice The femtosecond choice
Ophthalmology News - EyeWorld Magazine
283 110
216 144
True, 3