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Femto wars, part 2: The nitty-gritty
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While the interest in femtosecond cataract equipment from last fall's AAO meeting continued at this year's recently concluded ASCRS meeting (more than 1,400 people attended a live surgery session sponsored by Alcon), it is good to see the conversation turn more toward technical distinctions among the machines and their relative advantages. Alcon, with its tidy lead in cataract surgery equipment market share, has the greatest potential to gain market share by offering discounts on other equipment and disposables for prospective users of its LenSx laser. OptiMedica boasts a fluid interface that does not require applanation (and therefore distortion) of the cornea and other anterior segment tissues. LensAR promotes the demonstrated quality of its proprietary imaging system. And Technolas Perfect Vision suggests that its laser will be capable of assisting in cataract surgery as well as creating LASIK flaps.
Those are all features, but what about benefits? As commercial femtosecond lasers become more widely available and more patients are treated, benefits in safety and surgical and refractive predictability will undoubtedly alter this conversation and slowly eliminate surgeons' collective suspicion about the value proposition of this new, expensive technology. As other technologies such as lens implants and surgical instruments evolve around the capabilities of these new, highly precise machines, we can expect the debate about their utility to slowly fizzle. Twenty years ago, this happened with phacoemulsification. More than 10 years ago, it occurred with excimer lasers, and soon it will happen with femtosecond lasers.
Still, there is no reason to rush out and buy a machine. It is a dubious competitive advantage to have the first femtosecond laser in the community. While the first adopters may get the first local television news features and have some bragging rights, it is unlikely to significantly shift future local market share in cataract surgery. After all, we are facing an aging population that is doubling in size and a population of cataract surgeons that is declining. Everyone is going to be very busy in the near future.
Lastly, as competition among the four (and maybe more) femtosecond companies continues to heat up, it will be interesting to see what conflicts might arise over intellectual property. The question of which company owns the rights to the various parts of femtosecond laser-assisted cataract surgery is still unclear. Much as it occurred with the excimer laser, we might expect some legal tangles between the companies over patent infringement.
One thing is clear: The idea of femtosecond laser-assisted cataract surgery is here to stay.
- Disclosure: Dr. Hovanesian has no direct financial interest in the products or companies mentioned in this article.