LASERS IN CATARACT SURGERY

Recently, there has been considerable discussion about “all laser cataract surgery” both in our local media and in the world of Ophthalmology as well. Here are my thoughts at this point:

First, I love lasers. I ordered the first available YAG laser in 1981 at the University of Pennsylvania and we had a YAG laser for post cataract use when I opened Eye Specialists in Sarasota in 1984. Incidentally, by having a YAG laser in our office instead of requiring our patients to go to a surgery center, we have saved insurance carriers and our patients hundreds of thousands of dollars.

Throughout the years, many patients have thought that their cataracts were being removed with a laser while in actuality they were being removed with high frequency ultrasound. A device called a “femtosecond laser” has been developed to perform part of the cataract procedure. I am most interested in this technology and have participated in multiple meetings about it. I just wonder if it is ready for widespread use.

Before we discuss the femtosecond laser further, let me say that when I consider new technology to be ready, I will be an early adapter as I was with the use of ultrasound to remove cataracts and with the advanced technology intraocular lenses. We have had tremendous success with both of these technologies since their early days.

To date, there have been relatively few femtosecond cataract removals (thousands) compared to those done with ultrasound (tens of millions). In addition, the femtosecond laser is an “interrupted” procedure in that the laser is performed in one room and the lens is actually still removed with a traditional ultrasound machine in another room. At a recent meeting, one surgeon actually bragged that the manufacturer of his laser had updated its computer program seven times in the first two months that he used the laser. It was obvious that he was unaware that he causing much concern among his audience members.

There are important questions to ask if you are considering having cataract surgery with the femtosecond laser. These should include:

  • Who will perform the laser portion of your procedure?
  • Will all portions of the cataract surgery be performed by the same surgeon?
  • What is the additional cost of the surgery? (At present, neither Medicare nor other insurance companies cover any of the cost of the femtosecond laser)
  • What is the cost you will be charged to the laser manufacturer per eye?
  • Does your surgeon have an ownership position in the laser company?
  • Remember, the manufacturers of the femtosecond laser for the most part are also the manufacturers of the ultrasound equipment so they have a significant conflict of interest; they want both machines to be used on every case.

    Based on my research, the company which I believe has the best technology has just received FDA approval and still needs to go through the learning curve that I have described above.

    I truly look forward to using the femtosecond laser to help remove cataracts. I suspect that in ten years from now it will be used as widely as ultrasound is used today. As soon as the technology has been proven, I will adopt it, but it is difficult to know when exactly that will be.

     

     

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