A P R I L 2 0 1 6 O U T P A T I E N TS U R G E R Y. N E T 3 7
justify the expense of a laser and could structure an agreement where it could
be paid for through a lease agreement on a monthly basis," he says.
Partnering with an outsourcing company that brings the laser to your facility,
sets it up before surgery and breaks it down afterward is a great option for facili-
ties that will never have sufficient numbers to invest in a laser, that want to test
the laser's feasibility in their market or that need to build up their case volume
before committing to the technology.
"The outsourcing companies are professional and do a great job," says Mr.
Dawes. "Their technologies are well kept, and I think they provide a fantastic
service for a facility that's trying to get their foot in the door."
Clinical questions remain
Dr. Newsom was an early adopter of laser-assisted surgery for astigmatism cor-
rection, but is using the technology less and less. That's because his own
research found that the laser resulted in a statistically significant reduction in
the amount of astigmatism, compared with manual technique, but the difference
in post-op visual acuity was only 1 letter on the eye chart.
The laser makes lens fragmentation easier, and it's a little gentler on the
cornea, but that doesn't necessarily provide a better outcome, says Dr. Newsom.
He acknowledges there's potential benefit of using a laser to create a perfectly
formed capsulorhexis — the large circular incision in the anterior lens capsule.
"But as the body heals, that perfect circle changes shape," says Dr. Newsom.
"It's not the same 3 months after surgery. I never bought into the concept that a
perfect capsulorhexis results in better refraction."
He also cites a recent study in the journal Ophthalmology that shows laser
cataract surgery does not result in improved refractive results, and that it actual-
ly increases risks of complications of cystoid macular edema and capsular tears,
compared with manual surgery (osmag.net/ZEBzg6).
Dr. Newsome says the 2-step laser surgery process — surgeons break up the
lens with the laser before moving the patient to the surgical table for extraction
