Femtosecond Cataract Surgery

[MR1]

With all the talk and development of the femtosecond laser for cataract surgery got me thinking and I was wondering others opinions.

Femtosecond technology might soon be able to cut your incisions, LRI or AK's, make the rhexis, and liquify the lens. So all the surgeon has to do is stick in an I&A port and just suck out the cataract and then shoot a lens in.

To me, as a resident learning cataract surgery seems to take all the fun out of it. Now I know that is not what it is ALL about, but still.

Also if this happens to do you think general guys\girls will maybe start doing other things more, pushing into the subspecialities more than currently. Again as a current resident, learning cataract surgery is the main thing we do, and this would seem to make it 100x easier.

Do you even think this will be mainstream ever or just for the folks that can afford "refractive cataract surgery"

Lastly could this be the same conversation they were having ~20 years ago when phaco came on the scene.

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[bucknut101]

With all the talk and development of the femtosecond laser for cataract surgery got me thinking and I was wondering others opinions.

Femtosecond technology might soon be able to cut your incisions, LRI or AK's, make the rhexis, and liquify the lens. So all the surgeon has to do is stick in an I&A port and just suck out the cataract and then shoot a lens in.

To me, as a resident learning cataract surgery seems to take all the fun out of it. Now I know that is not what it is ALL about, but still.

Also if this happens to do you think general guys\girls will maybe start doing other things more, pushing into the subspecialities more than currently. Again as a current resident, learning cataract surgery is the main thing we do, and this would seem to make it 100x easier.

Do you even think this will be mainstream ever or just for the folks that can afford "refractive cataract surgery"

Lastly could this be the same conversation they were having ~20 years ago when phaco came on the scene.

I think this will eventually be the way most catarct surgery is done but I think it's going to take awhile. This will be due to the cost of peforming the surgery with the laser. When we do LASIK or PRK we have to place a treatment in card in the machine before performing the treatment. These usually cost several hundred dollars. So in addition to purchasing the laser, it costs money every time we use it. I would imagine that the laser companies will do something similar with cataract surgery. And I seriously doubt Medicare and other insurance companies will cover these additional costs.
Most likely it will intially be for patients that want the best surgery possible, the ones with the extra money in their pockets to pay for premium surgery. Just like how a select few of current patients pay for premium IOL's.

In addition I doubt that the femtosecond will be able to do all types of cataracts. Extremely dense ones, mature ones, small pupils, etc. would likely prove difficult for the laser to do. So good phaco skills we always be needed, just like sometimes you need good ECCE skills to do some cataracts that can't be phacoemulsified.

The femtosecond laser technology is exciting however. I just read something about peforming a DALK by cutting the corneal tissues and simply GLUING the donor button in place. If that becomes the mainstream the suturing skills I've spent the last year of fellowship perfecting will be useless. Anybody could do a transplant using the laser!

 

[orbitsurgMD]

With all the talk and development of the femtosecond laser for cataract surgery got me thinking and I was wondering others opinions.

Femtosecond technology might soon be able to cut your incisions, LRI or AK's, make the rhexis, and liquify the lens. So all the surgeon has to do is stick in an I&A port and just suck out the cataract and then shoot a lens in.

To me, as a resident learning cataract surgery seems to take all the fun out of it. Now I know that is not what it is ALL about, but still.

Also if this happens to do you think general guys\girls will maybe start doing other things more, pushing into the subspecialities more than currently. Again as a current resident, learning cataract surgery is the main thing we do, and this would seem to make it 100x easier.

Do you even think this will be mainstream ever or just for the folks that can afford "refractive cataract surgery"

Lastly could this be the same conversation they were having ~20 years ago when phaco came on the scene.

You might see a combination of the technologies, with phaco as an available adjunctive emulsification technique to support photoemulsification/photolysis/photodisruption. I can see it being used first with clear-lens procedures in combination with Intralase LASIK as a refractive procedure with multifocal IOLs.

With the future of Medicare reimbursement subject to constant downward pressure on payment, I can't see a practical rationale for this expensive technology over standard phaco unless the lid is taken off the present cap on balance billing for Medicare services.

 

[ksidoc]

With the future of Medicare reimbursement subject to constant downward pressure on payment, I can't see a practical rationale for this expensive technology over standard phaco unless the lid is taken off the present cap on balance billing for Medicare services.

Do you think this is a possibility? I often wonder if that would relieve some of the pressure on the Medicare system and would allow physicians the ability to increase their income stream. I am taking the MCAT this Friday, I can't imagine doing anything else other than medicine, however with the sinking reimbursement rates I wonder if I can pay off the debt of optom school as well as medical school. Would just like to hear more opinions on this topic.

 

[CastroViejo]

I am starting residency next year. My concern is that this technology is too new/expensive for residencies to train with it, but it might be pretty big soon after residency, and we wouldnt really have gotten trained with it. Is doing the surgery with femtosecond fairly easy or would it require a lot of weekend seminars or something to learn the skills?

 

[200UL]

It would be surprising if this took off for cataract surgery in a significant level anytime soon due to money issues - and other things. My comments below apply to an intralase type system trying to accomplish wound construction / rhexis...

1. Are surgeons going to spend hundreds of thousands of dollars for an intralase dedicated to cataract surgery when reimbursement is continuously threatened? I know hospitals won't be signing up for it in big numbers.

2. Will surgeons want to spend $200 for a single suction ring (intralase) in order to do the rhexis?

3. Even the most average of surgeons can make a wound and do a rhexis in the time it takes to place the suction ring, swing the patient under the intralase, dock the intralase, and do the rhexis..... In other words, it is hard to envision time savings with the current platforms.

4. Will patients like having the ring of subconjunctival hemes that often come with placing the intralase suction ring? Many patients have become accustomed to pain free surgery without hemes that will last for the next 3 weeks.

There was a lot of talk at the academy last year by the "industry leaders" on this subject. Some people will say anything for a price.

While this post may seem negative, I do realize that phaco may very well be obsolete in 20 years or even sooner. There will be something different - something better. It may be femtosecond technology or something else. However, the "industry leaders" sound foolish when they discuss the current femtosecond platforms as the answer.

 

[MstaKing10]

This is pretty exciting technology and I think there will be a place for it in some way in the future. However, I don't think this will be replacing phaco anytime soon. The above poster makes a lot of really good points. The only way this will take off is if: the procedure is safer, quicker, offers better outcomes, and/or is economically more lucrative for the surgeon. I'm not certain that laser technology makes any of these true...yet!

 

[Mirror Form]

As some other posters have already mentioned, it is highly unlikely that this will ever be able to compete with the current technology in terms of speed and "cost-effectiveness." So for the standard patient who isn't willing to pay thousands of dollars out of pocket, this won't be used.

However, it does give us one more thing in addition to premium lenses to offer patients who are willing to spend money out of pocket. I imagine some ASC's or hospitals will have them available for rent. So, we'll probably all be using it occasionally someday since it does have some nice advantages.