A P R I L 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 5 3
lens fragmentation easier to perform, but my current technique of phaco-free in
99% of up to grade 3 lenses is a staged development that is sure to be replaced
by better technology that can ultimately go completely phaco-free 100% of the
time, including for the dense lenses.
Demand for improved refractive outcomes has upped the demand for tech-
nology that delivers the desired results. In my opinion, lasers are sitting on
the cusp of the future standard of care in cataract surgery.
OSM
patient convenience and eliminates risk, however minimal that risk might be, of anterior instability when moving
patients to the surgical bed.
The study notes that setting up the laser in another room, however, helps maintain overall efficiencies by freeing up
the OR during the laser portion of procedures for conventional cataract surgery. Multiple surgeons can use the laser in
rapid succession or a single physician can perform the laser portion of the procedure before sending patients to the
OR for manual removal of the diseased lens and implantation of the IOL. The additional room needn't be sterile since
the laser incisions are not entered, but it must be a "clean" space.
Performing the 2-step process slows down the surgical day — cases take 20% to 30%, or approximately 6 min-
utes, longer than conventional surgery, says the study — especially when surgeons are the working through tech-
nology's learning curve. Surgeons can average 2 to 4 cases an hour if the laser is placed in the OR, but 6 to 8 cases
if a dedicated surgeon performs the laser portion of the procedure, according to the study.
What about the cost of adding the technology? It can be prohibitive. The study notes that the average laser costs
between $400,000 and $550,000, which doesn't include annual service costs of $40,000 to $50,000 and per-click
fees of $300 to $450 per eye.
Surgeons catering to patients who don't demand enhanced post-op refractive outcomes might not think the signifi-
cant costs are worth it, but surgeons in a market where patients have higher post-op vision expectations might look at
the expenses as the cost of doing business.
— Daniel Cook
Dr. Wang (drwang@wangvisioninstitute.com) is the director of
Wang Vision Cataract and LASIK Center in Nashville, Tenn.
