Laser cataract surgery: More bang for the buck

Chicago-Laser cataract refractive surgery may offer more advantages to a clinical practice than LASIK does. Stephen Slade, MD, discussed those advantages during Refractive Subspecialty Day at the American Academy of Ophthalmology annual meeting.

Far more ophthalmologists in the United States seem to being performing LASIK compared with laser cataract refractive surgery, based on the responses of the attendees during this symposium presentation. With the aging of the population, Dr. Slade suggested that ophthalmologists might consider incorporating femtosecond laser cataract refractive surgery in their practices. Aside from those numbers, incorporating a femtosecond laser into a practice would cut in half the amount of hardware required compared with using both excimer and femtosecond lasers. In addition, insurance covers cataract surgeries but not LASIK procedures.

“Laser cataract [surgery] might be a good consideration for ophthalmologists,” he suggested.

An important question from ophthalmologists about laser cataract refractive surgery concerned the impact that use of the laser will have on patient flow. Dr. Slade commented that while a laser cataract refractive surgery procedures require more time than LASIK procedures, he suggested performing fewer laser cataract procedures per hour and spending more time with the patients to make sure they get better results.

“This is actually compensated better,” he stated.

Dr. Slade also recognized that laser cataract refractive surgery has been considered somewhat controversial; however, he sees this as a healthy part of the process of questioning a new technology, just as what occurred with the introduction of phacoemulsification, IOLs, and LASIK.

“This questioning is good because it drives science,” he said and pointed out the number of articles and books published on the precision, safety, efficacy, and review of this new technology.

The results of the “real-world” test are that currently there are 280 femtosecond lasers in 42 countries; 60,000 procedures have been performed and 1,000 ophthalmologists trained, Dr. Slade pointed out.

A caveat that he offered is that no technology should be viewed as a snapshot in time.

“The factors that should be considered are the speed with which the technology is moving as well as the upside potential. The upside of combining phacoemulsification machines with digital femtosecond lasers is virtually limitless,” he said.

In support of that, some lasers in fact are already on the fifth software iteration, and some have new interfaces, such as that in the LenSx laser system (Alcon), with dramatic improvements.

“The free-floating capsulotomies created using femtosecond lasers have dramatically improved in just a couple of years,” Dr. Slade emphasized.“Laser refractive cataract surgery provides a gentler surgical touch. The refractive results are more reproducible and improved. The procedure is very patient friendly and enables future technologies, such as better phacoemulsification and better surgical techniques. For advanced-technology IOLs, the procedure will elevate their performance, and it will change our field,” Dr. Slade concluded.

Dr. Slade did not indicate any financial interest in the topic.

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