EyeWorld Asia-Pacific September 2014 Issue

50 EWAP CAtArACt/IOL September 2014 Dr. Lawless said that in Australia, it is presented as a way that a surgeon prefers to perform the procedure, and the explanation often highlights safety and accuracy. “Most people emphasize the precision and reproducibility of the laser compared to manual surgery, and this does seem to resonate with patients and referring optometrists,” Dr. Lawless said. Dr. Dick said that femtosecond cataract surgery is presented as personalized, individualized surgery with greater precision and accuracy. “We do not state that [femtosecond] surgery is safer,” Dr. Dick said, but he does believe it to be safer. The technology shows good results for pediatric and infant cataracts, as well as “superb primary posterior capsulotomy,” he said. Additional cost A factor to consider in femtosecond laser use is the increased cost, as it is considered a premium procedure and often comes with a price that is not covered by insurance. Dr. Dick said that in Germany, this extra cost is about €1,500 per eye (or about US$2,089), which is not covered by insurance. Dr. Alió said that femtosecond cataract surgery is considered a highly premium procedure, and currently the added cost is 800 per eye (or about US$1,114). “This is just to cover the cost as there is no revenue for the clinic or the doctor,” he said. Australia features a co-payment system, so patients pay out of their own pocket, and the procedure is not covered by government or health funds, Dr. Lawless said. “Health funds and the government do contribute, however, to the cost of surgery as they would ordinarily,” he said. Dr. Lawless added that the concept of premium surgery is not a significant factor in Australia because surgeons mainly choose premium options as they see fit for the patient. “They do not get paid more for doing these procedures, so they do what they think is best,” he said. “Similarly, if patients have insurance, there is no extra financial burden with premium style lenses; it is a much truer situation where the surgeons and patients discuss what would be best for them and the surgeon then selects the lens he/she thinks is most appropriate.” Dr. Daya said that in his practice, all patients undergoing cataract surgery or refractive lens exchange get femtosecond laser technology. “We increased our prices modestly and were able to do so as we could estimate more accurately the numbers of patients undergoing surgery with the technology,” Dr. Daya said. “ As a result, our uplift per case is lower than our competitiors.” Areas without femto Dr.Barry said that Ireland currently does not have a femtosecond laser in use. This relates to the price and the fact that Ireland had recently been in a recession more than anything else. Dr. Barry said that the country’s recession has caused problems for not only patients but insurance providers as well, and this makes use of the femtosecond laser and the extra cost impractical. “I think surgeons here are very excited about the potential of femto-assisted laser cataract surgery,” he said, noting that he expects the technology to be acquired in the country soon. He welcomes the delay in the adoption of the technology because he is currently working on a study to create a database for consecutive femtosecond laser cataract patients, including those patients where a procedure is abandoned because of complications. There are plans to present results from this study at the 2014 ESCRS meeting in London. This will help determine if femtosecond cataract surgery does what it advertises and if the accumulation of a number of small details can work better than the human hand. “A lot of the hype includes an implication to the patient that femto is better because it’s more expensive,” Dr.Barry said. “It may well be better, but it’s not better because it’s more expensive.” The data being examined aims to determine what the effect of the femtosecond laser is. “I think that the worldwide cataract surgical community and industry will have a profound interest in the outcome of this study”, Dr. Barry said. EWAP Editors’ note: Drs. Alio and Barry have no financial interests related to their comments. Dr. Daya has financial interests with Bausch + Lomb/Technolas (Munich, Germany). Dr. Dick has financial interests with Abbott Medical Optics (Santa Ana, Calif., U.S.) Dr. Lawless has financial interests with Alcon (Fort Worth, Texas, U.S.). Contact Information Alio: jlalio@vissum.com Barry: peterbarryfrcs@eircom.net Daya: sdaya@centreforsight.com Dick: burkhard.dick@kk-bochum.de Lawless: michael.lawless@visioneyeinstitute.com.au Global - from page 49