eliminate posterior opacification (secondary cataracts). He says lasers
make his surgeries more predictable. "The lasers are very precise and
much more accurate," he says. "If you want [a cut] to be a certain size
or depth, you can control that much better than if you used blades or
other instrumentation."
Bruce Saran, MD, focuses on posterior segment procedures at
Chester County Eye Care, and uses lasers for nearly all of them —
retinal tears, panretinal photocoagulation to prevent retinal detach-
ments, poor blood flow and treating leaking blood vessels. "In terms
of a profit center, having an intraoperative laser for retinal surgery is a
very positive thing," he says. "It's better for the patient, it's better for
the surgery center. It's good medicine, and it's good business."
At Zion Eye Institute in St. George, Utah, surgeons use the same
YAG laser for posterior capsular opacities, vitreolysis for breaking up
floaters, selective laser trabeculoplasty (SLT) and peripheral irido-
tomies, says administrator Zachary Cox, COE. Mr. Cox says Zion's
most profitable laser procedure is the YAG laser capsulotomy: "It's so
quick, the post-op [recovery] is very easy, and it's a lot safer."
Useful for cataracts?
One surgery for which Zion doesn't use a laser, though, is cataracts.
"We found there's no benefit to the patient," says Mr. Cox. "All it does
is make the surgery a little bit easier for the surgeon."
Other centers, however, fully embrace laser-assisted cataract surgery.
Dr. Ondrias cites its clinical benefits — a "little less" corneal edema, a
"perfect" capsulorhexis and a "little quicker" visual recovery, less
phaco energy used in the eye, and less fluid needed to irrigate and
aspirate the lens.
Paul Mann, MD, of the Mann Eye Institute in Houston, Texas, says
lasers make capsulotomies much less tricky, adding that they place
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