A CME Supplement in EyeWorld October 2015, entitled Step by step: Clinical and practical implementation of laser-assisted cataract surgery included an interview with Dr. David Dillman on page 4, Mobile laser-assisted cataract surgery. CLICK HERE to view the entire supplement.
Hear more from Dr. Dillman in our 3-part MoFe Implementation video series HERE.
Tapping into the benefits of shared-access models
When entering the arena of laser-assisted cataract surgery (LACS), shared access through a mobile laser program may give clinicians an innovative pathway to offer this technology to their patients.
When I began investigating this option approximately 3 years ago, I visited 3 facilities and watched 5 surgeons perform approximately 100 LACS procedures. Even more importantly, I talked with them about why they adopted this technology and its advantages for patients (Figure 1). I quickly became a believer.
To adopt femtosecond laser technology, surgeons must believe it is a better technology for their patients compared with the techniques they used previously—not a moneymaker.
I recommend LACS to everyone, but I especially ask patients with complex cases to have this procedure. However, many patients cannot afford it, so I discount my fee by approximately two-thirds in those cases. Some patients cannot afford even the discounted fee, so I perform the procedure at no charge. Although I lose money in those cases because I still need to pay per-use fees for the laser, I consider this practice worthwhile.
When I initially adopted this technology, I could not afford it, so I explored other avenues. In my area outside Chicago there were no femtosecond lasers, so I could not perform LACS procedures in a nearby facility.
I had partnered with a mobile company, Sightpath Medical, in 1998, so we developed the first mobile LACS program. This company uses the LenSx platform. There are now 2 additional companies that offer mobile LACS programs: ForTec Medical, which uses the Catalys platform, and Precision Eye Services, which uses the LENSAR platform.
We performed the first mobile laser cases in 2013 in Hoopeston, Ill., with 2 surgeons sharing access to 1 laser. I performed 12 cases the first day. Two years later there are 174 sites in 36 states, with 311 active surgeons and 27 lasers in the field (Figure 2). This program has been used for nearly 23,000 cases.
Committing to mobile
Although shared access through a mobile LACS program reduces expenses associated with purchasing the femtosecond laser, the practice must commit to a specific amount of time, as well as a certain number of cases per quarter and per operating room day (Figure 3). For example, surgeons cannot ask the company to deliver the laser for 1 case on a specific day.
In addition, clinicians must purchase disposable docking devices and pay laser user fees for each case. In some instances, surgeons may be required to pay a penalty if they do not meet the quotas specified in their contracts.
Although shared access through a mobile LACS program requires a commitment, it is less than that required when purchasing a femtosecond laser. The mobile laser program made it possible for us to implement this technology and offer the benefits of this device to our patients.
Dr. Dillman is in private practice at Dillman Eye Care Associates, Danville, IL.