BLOG: Doctors debate, patients decide

ByJohn A. Hovanesian, MD, FACS

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In the cover story of this issue of Ocular Surgery News, we discuss the debate that has continued for almost 20 years on mechanical vs. laser microkeratomes for LASIK surgery.

John A. Hovanesian

For surgeons, the pandemic-driven resurgence of this procedure has raised demand among patients and increased the number of practices offering LASIK. To newcomer practices, avoiding the expense of a femtosecond laser has benefits to their bottom line. While there are studies suggesting the benefits of both laser and no laser for cutting LASIK flaps, public opinion has strongly favored the “all laser.” In the U.S., of the 3,600 surgeons who perform LASIK, 75% have access to a femtosecond flap maker, and about 80% of cases are performed that way, but of the 350 surgeons who do the majority of the surgery, the use of lasers is about 99%, according to Market Scope.

By contrast, in the U.S., about one-third of the 10,000 surgeons who perform cataract surgery have access to a femtosecond laser, and only about 12% of surgery is performed with a laser.

In other words, because fewer surgeons perform LASIK — a more consumer-driven procedure — more of those surgeons have invested in the public’s desire for laser refractive surgery. This has not happened with cataract surgery.

I believe we will see growth in the percentage of cataract surgeries performed by laser. Retiring surgeons will be replaced by those who understand the need to fulfill the public’s desire for more “advanced” surgery, and there will be a continuing drive toward more premium results, which lasers uniquely allow. Also, exciting new lens implants such as the LensGen Juvene lens and others will require more consistent capsulotomy that lasers deliver best.

None of these market forces that will drive the future depend entirely on the scientific superiority of one platform over another. They depend on educated consumers making a decision. In cases in which safety is not a concern and the patient is paying for the technology, that’s probably the way it should be.

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