Newest technology may not be the best fit for all surgeons

In my last commentary, which accompanied part 1 of the round table discussion on femtosecond laser-assisted cataract surgery in the Dec. 10 issue, I made the argument that it is now possible for nearly every cataract surgeon in the continental United States to access a femtosecond laser one way or another. In this commentary, I would like to share my current thoughts regarding the utility, cost and politics of femtosecond laser-assisted cataract surgery, or FLACS. I suspect my comments will be controversial to some, and for that I again apologize. I would also like to disclose that I consult or have consulted for several companies involved in FLACS, including Alcon/LenSx, AMO, Bausch + Lomb, Lensar, Sightpath and Precision Lens.

The femtosecond laser is, to me, an extremely precise computer-driven scalpel. It is incumbent on the surgeon and his or her assistants to formulate a surgical plan, program the laser and properly dock it to the patient’s eye. However, once the treatment is started, the surgeon’s primary responsibility, other than reassuring the patient and helping to steady the eye, is to monitor the treatment and abort if something untoward occurs, such as a loss of suction.

While this might sound simple, I personally did not find that FLACS was less stressful or made the surgery easier. Significant skill is required to perform a flawless FLACS, both during the laser treatment and the subsequent cataract removal and lens implantation. For me, there was a learning curve, and about 25 cases were required before I was comfortable, and my skills and judgment continued to increase to as many as 100 cases. In addition, FLACS definitely did not make my surgery faster or less expensive, with each case at my volume costing me about $750.

Click here to read the full publication exclusive, Lindstrom’s Perspective, published in Ocular Surgery News U.S. Edition, December 25, 2014.