BLOG: Laser cataract: What it brings to my practice

ByJared Younger, MD

Welcome to the debut post of my new blog on laser cataract surgery. In this space, I will discuss what you need to know about successfully implementing this technology into your practice. I will review my own process and flow for everything from the patient discussion and education all the way to tips, tricks and case studies demonstrating specific pearls you can start using in your practice.

In this first installment, I review how our practice implemented the new laser technology and how I present this to patients. Next, I continue with laser and premium IOL conversation.

Being part of a premier ophthalmology surgery center, great staff and flow are critical; however, the best technology is a must. As laser cataract surgery systems became available, I knew that our center needed to use the technology to stay competitive. I believed that patients would ask for the laser, and I knew that the devices would continue to improve. After gaining experience performing laser cataract surgery at an outside center with an early-generation laser, I recognized what features of the device were important. After comparing platforms, I then was confident that the center should implement the Catalys (Johnson & Johnson Vision).

Features, fit and flow

As a matter of practicality, the Catalys would fit in our eye surgery ASC, and I was sure our surgeons would appreciate patients being “loaded” in the laser bed by nursing staff. I also had confidence that the flow would work in our center and that the laser system would likely draw surgeons in. There were growing pains in the first year, of course, but surgeons quickly became comfortable, drawing on their LASIK experience. It helped that the center had a good relationship with a manufacturer we trusted, as its support is instrumental in the ramping up process.

Quickly up and running with the flow, our surgeons became increasingly adept at and satisfied with the laser procedure. One of the most powerful features of the Catalys system in my opinion is its superior imaging capability and the ease of use with the touchscreen. This allows for making adjustments on the fly if needed without causing stress. Also, we found that any time added to cases was minimal. Cases are typically 30-minute blocks. During the first few months as we were implementing the Catalys, we changed the block time to 45 minutes. By the 4-month mark, we were back to our 30-minute blocks. It should be noted that using the laser does require more staff; an RN is cross-trained as the laser technician and helped by an expeditor for transferring patients.

The way practices integrate the laser into the ASC is paramount because it sets the stage for a core group of users. In our experience, the procedure grew organically quite fast. More surgeons are drawn to the laser because of its benefits, patient demand and the fact that it really was not slowing down patient flow.

About those laser benefits

It is important to stick to the key points that will resonate with patients when talking about the laser’s benefits: It translates to a better patient experience, and it enhances refractive outcome compared with manual surgery. To communicate this during the consultation, I have a stepwise approach using the laser as a central talking point. Even if a patient has not received any educational materials prior to the visit, we can still introduce the information efficiently and effectively.

I have a designated consult day for cataract patients, which puts the day in focus and helps technicians with the workup time. On consult days, the appointment times are longer and the testing room is available. As the technician speaks with the patient, he or she briefly mentions what the test is and why it’s being performed. During topography, for example, the tech will say, “This is a test that measures astigmatism. The doctor will explain more.” Planting a word or an idea gets them thinking during the next step in the education process.

It’s movie time

After the technician is done with the initial testing and history and has instilled dilation drops, we have patients stay in that room and watch a laser cataract surgery video. The video notes that there will be IOL options, but it does not present a menu nor does it imply they have a difficult choice to make. It explains what a cataract and how it is treated, and it includes a few key images of manual compared with laser surgery. There is a short explanation of astigmatism and how it is corrected by the laser. The video takes about 4 minutes, and patients are engaged.

This has proven to be a simple, effective approach in our practice. Some surgeons may say they are too busy to let patients stay in an exam room while dilating; however, I recommend setting up the schedule to accommodate this valuable approach. After the usual dilation time, I enter and proceed with my discussion, and I have found it to be amazing what patients remember from the video. When I first say “laser,” patients are nodding and they sometimes interrupt and say, “Oh yeah, I already saw that on the video. It was really cool.” The rest of my education is through using the room’s touchscreen monitor and describing cataracts, the laser and my best recommendation for an IOL choice.

Conclusion

Incorporating laser cataract surgery has been hugely successful in our center and for surgeon practices. With careful planning and by choosing a user-friendly and intuitive system like the Catalys, practices can differentiate themselves by consistently achieving outstanding premium visual outcomes even with the refractive bar now being set so high.

More on the IOL discussion and my theory on price next time.

Disclosure: Younger reports he is a consultant to Johnson & Johnson Vision.