This is the first in a series of articles on the subject of femtosecond laser cataract surgery.
My original post
Back in 2011 I wrote this post about laser cataract surgery on my old website:
Old post
Many patients have now heard about the new femtosecond, laser cataract surgery following a recent segment on television.
This subject is increasingly being raised in discussion when patients come to see me for cataract surgery.
The committee at the Victoria Parade Surgical Centre where we regularly operate, recently met to discuss the possibility of purchasing one of these devices. To date there are two in operation in NSW only. After the meeting it was decided that we not be acquiring one. The reasons are as follows. The machine cost more than half a million dollars and the on going maintenance nearly $100,000 per annum. Further the per patient cost is $500. In order for the centre to break even per patient, an additional cost of more than $1500 needs to be imposed on each patient. Now who in their right mind would want to pay this additional sum for their cataract surgery? Particularly since there is no tangible benefit other than to be able to boast that their surgery was done by the state of the art method.
If there was a markedly better outcome or increased safety then maybe, but there isn’t either. Thus at present this type of surgery is nothing more than a marketing gimmick. Now make no mistake, that in the future it will probably be the way to go, but until it becomes significantly cheaper it will not become mainstream.
All that can be said about it is that it is just a “different” way of performing an already excellent operation, not a better way.
How things have changed!
That is how I felt about it then and I feel it important to highlight the fact that I have clearly changed my mind having started performing it.
So what has changed? Well firstly I attended the AUSCRS meeting in Queenstown New Zealand in 2011 where the evidence for its benefits was presented. I also saw the huge and rapid uptake by other surgeons. I decided to be open minded about it and started performing it. The end consequence is that I now am firmly sold and would rather do laser cataract surgery every time if it wasn’t for the additional cost of doing it.
The experience reminds me of the early days of phacoemulsification (the current technique). When I first started my ophthalmic training everyone was performing extracapsular cataract surgery and phaco was only just coming into being. The comments from surgeons at the time where identical to what they are now saying in relation to femto such as “we have a perfectly good operation (extracap) so why switch to phaco? ” Its significantly more expensive, takes more time and has no better outcomes. The reality was of course that phaco is better and it has completely replaced extra cap surgery. During those early days, registrars undergoing training where told that they had to master extracap surgery first before learning phaco. Well now you would be hard pressed to find a surgeon that can perform an extracap procedure.
To date, there are now literally hundreds of articles published in peer review journals clearly demonstrating its benefits.
In have been conducting a running audit of my own results and can clearly see that the end refractive results are superior to conventional surgery.
In my next instalment I will be presenting the objective, published evidence currently in the literature