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Does femtosecond cataract surgery pass the sniff test?
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In a recent blog, I described the three stakeholders in any new medical offering: the patient, the doctor and the drug/device industry. For a new technology to succeed, I believe, it must serve all three parties in reasonable measure.
Femtosecond laser-assisted cataract surgery is no exception to this rule. In the minds of many surgeons, it’s a windfall for the device industry, with high capital and recurring charges, but they would say it offers less clear value to patients and surgeons. These understandably hesitant colleagues would argue that those who have paid to acquire the technology have “bought in” to the idea that it helps patients. Yet the procedures consume more OR time than traditional phaco surgery (see Jordon Lubahn’s excellent study in this month’s Journal of Cataract and Refractive Surgery on this topic), and they would say it offers no added benefits.
I’m not so sure about the last part. Even as a late adopter of femtosecond laser cataract surgery, I believe the time has now arrived to begin using femtosecond lasers for cataract surgery — at least for those of us whose patients understand, desire and can afford the new technology.
It seems each month we see more studies showing the relative benefits to patients, such as this month’s study by Robin Abell, again in JCRS, which showed significantly less endothelial cell loss when the femtosecond laser and not phaco energy is used to fragment the cataractous lens. The September 2013 issue of JCRS carried a number of excellent articles by Abell, Gerd Auffarth, Burkhard Dick and Ina Conrad-Hengerer on all aspects of the clinical value of femtosecond laser surgery.
Furthermore, patients are increasingly aware of this new modality. While we have a duty to protect our patients from the dangers of harmful treatments, we also have one to respond to their wishes when they ask for new technologies that have reasonable value.
I believe the market speaks to every technology, and its words are now favorable for femtosecond laser cataract surgery. Many in our industry have already said that we are seeing a repeat of what happened 25 years ago with the adoption of phacoemulsification. That technology, with its expensive equipment and dangers to patients in its earliest form, met vigorous opposition during its early years. Yet history didn’t treat well those who were the latest adopters of phaco. For me, there’s little point in reliving that portion of history.
References:
J Cataract Refract Surg. 2014;doi:10.1016/j.jcrs.2014.03.024.
J Cataract Refract Surg. 2014;doi:10.1016/j.jcrs.2014.05.031.