Tuesday, March 29, 2011

Laser Cataract Surgery

Hello from San Diego and the American Society of Cataract and Refractive Surgeons Convention! The organizers tell us that attendance is up and that the city is full. The weather has been pretty iffy which is good news for the organizers (the doctors don't go to the beach), and not such good news for the doctors' families (the doctors don't go to the beach)!

The buzz, the big news, is all about laser cataract surgery, specifically "Femptosecond Laser" cataract surgery. There are no fewer than three laser platforms that can do parts of the cataract surgery, and two of them are now FDA approved (LensX and LensAR). These lasers are designed to do several things that are now completely under the control of the cataract surgeon: make incisions, including incisions to treat astigmatism, enter the cataract itself (capsulorhexis), and soften the cataract so that it can be removed. On paper these are all very exciting developments because of the very repeatable and reproducible aspects of the procedure.

What does Dr. White think? Is this a "now" thing, something that we will or should see as a standard part of cataract surgery? Is this the next big transition in cataract surgery, the next "manual to ultrasound"? In a word, no. The transition to a fully manual surgery (so-called extra-cap) to ultrasound (phaco) created tremendous efficiencies and time savings which allowed for an equally tremendous decrease in the actual cost of cataract surgery. The "entry fee" to buy the equipment necessary was in the $10's of thousands, and the new technology was entirely covered by insurance for everyone.

Now? The cost to acquire the lasers is $500-750,000. Each laser procedure has an additional cost of $3-500 before the surgeon's fee and before any payment to cover the cost of the machine. Adding the laser to the cataract procedure will double the time it takes to perform the surgery and double the space necessary to do so. None of the additional expenses will be covered by insurance, and in the hands of the nation's best surgeons there will be minimal, if any, improvement in outcomes.

While this is simply thrilling, Buck Rogers type science stuff, for now it appears that the Femptosecond Laser for cataract surgery is a technology in search of a market.

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