Warming up to Femto

The following article appeared in the April issue of Ophthalmology Management: 

Warming up to Femto



Many moons back, I wrote about how the femtosecond laser in cataract surgery looked interesting, but took too much time, had too many complications and was way too expensive. Later, I wrote the technology had improved, but I saw no way I could ever have one because it was still too expensive. Last year, I wrote that I’d seen one in action; it was really, really cool, not as inefficient as I’d thought, and I really wanted one, yet still saw no hope of affording one in small-town Tennessee.

Last week, I did my first laser cataract surgeries. How did this happen? Especially being one of the most vocal critics of femtosecond technology in cataract surgery?

Many of us simply don’t have the volume to afford an outright purchase or even a lease. The creative folks at Sightpath, a company I had used in an earlier incarnation years ago for their mobile excimer services, developed, tested, and had approved by Alcon a mobile application for the LenSx laser. Dr. David Dillman was the first surgeon to use this service. I was the second. (I have no financial interest in either company.)

If you have a high-volume center and several surgeons, it probably makes sense to shop around and buy. But with this model, you pay per case. With a minimum 10 cases per visit, the mobile femto laser comes to the office once a month. Sightpath calls it ReLACS (refractive laser cataract surgery), although a certain Frankie Goes to Hollywood song gets stuck in my head when I hear that.

You’ve probably read about the learning curve with femtosecond laser cataract surgery. There is one, but it wasn’t much of a problem even with my initial cases. While I had some difficulty with the wounds (side-port incisions can be nearly invisible and hard to find), the rest of the procedure was picture perfect. I’m happy to report I had 12 out of 12 perfectly complete capsulotomies. Likewise, nuclear fracturing was consistent and definitely beneficial. Most amazing was the beauty and precision of the corneal arcuate incisions. They looked almost jewel-like at the slit lamp the first post-op day. Surprisingly, the most common problem I’ve heard reported, difficultly with cortical cleanup, posed no problem.

While I obviously don’t have any short- or long-term data to report, I will say beyond a shadow of a doubt, this technology is here to stay. Our patients were excited, the staff was amazed, and after just one day there was no question, if any of us were having cataract surgery we’d want this technology used.

Hopefully in the future, methods will be devised to lower costs and make this technology more affordable, and perhaps the government will back off and allow people the freedom to just pay for the laser technology without involving refractive considerations. Until then, there now exists a mechanism to make this technology accessible to more patients. Without the substantial overhead of buying and maintaining a laser, there’s much less pressure to “encourage” patients to pay for it!