Practice carefully considers femtosecond laser purchase

"Our practice includes five refractive surgeons who collectively perform about 5,000 procedures annually, and we have a record of innovation, although that does not include being pioneers with the femtosecond laser microkeratome. While saying no, no, no for several years to the idea of purchasing that instrument, we have been watching reports of its outcomes closely. Based on more recent studies from a number of respected surgeons, we decided within the last year to bring a femtosecond laser microkeratome into our practice," said Dr. Lindstrom, adjunct professor emeritus, Department of Ophthalmology, University of Minnesota, and founder of Minnesota Eye Consultants, Minneapolis.

He reviewed some of the clinical and economic reasons that were weighed as he and his colleagues considered acquiring a femtosecond laser microkeratome and what their experience has been.

With respect to complications, Dr. Lindstrom noted that earlier there seemed to be a safety advantage for mechanical microkeratomes. Currently, however, the contest between the femtosecond laser and mechanical keratomes is more of a "horse race."

"Overall, complication rates are probably similar for the two flap creation procedures," he said.

The risk of microstriae is about equal, while there are more inflammatory syndromes with the femtosecond laser. However, they are not visually significant and can be managed well with fairly aggressive use of steroids, while the laser is superior with respect to epithelial defect risk and it also avoids problems associated with bad flaps," he said.

Not only are such complications as buttonholes and incomplete flaps eliminated, but flap quality is reproducibly better with respect to centration, depth, and diameter, Dr. Lindstrom added.

From an economic standpoint, the femtosecond laser eliminates the cost of purchasing blades. However, the femtosecond laser flap procedure still costs more per case and each case now takes longer.

"In most practices, the added cost can be passed on to the patient, and the surgeons within our practice already had some excess capacity. With that in mind, we were willing to take the extra time involved to generate better outcomes in what we consider is our premium practice," Dr. Lindstrom said.

He added that in the first series of cases performed with the femtosecond laser microkeratome and VISX laser, bilateral LASIK could still be completed in 12 to 15 minutes.

"The laser definitely reduces throughput, but the longer time needed is not a disaster, and the new 30-kHz model should increase efficiency," Dr. Lindstrom said.

Although some surgeons who use the femtosecond laser microkeratome suggest it has the potential to grow volume with increases in leads, consults, and ultimately cases, Dr. Lindstrom noted that has not been a universal finding or a key deciding factor.

"We didn't get the laser because it might increase case volume, although due to our increased price per case we have realized an increased profitability per patient. However, our primary motivation is to provide better outcomes," Dr. Lindstrom said.