Today’s meeting was wholly devoted to femtosecond laser cataract surgery. The meeting became quite heated with many people, passionately expressing their views both for and against it. My impression was the the naysayers where mainly arguing about the cost. Brendan Vote from Tasmania was in my mind the most interesting speaker. He gave two presentations, one showing that the surgery at present is not economically viable and a second presentation where he presented data looking at the electron microscopy of the laser created capsulorhexis of both the femto and the non femto cases.
Cost
There is no argument that at present this type of surgery is not cost effective. He said and I quote “Multivariate sensitivity analyses revealed that LCS would need to significantly improve visual outcomes and complication rates over PCS, along with a significant reduction in cost to patient, to improve cost effectiveness”. He showed data that at present cost effectiveness in $/QALY was AU$92,862. It would need to be less than $50,000 to be cost effective. The total QALY gain for LCS over PCS was 0.06 units. He also presented a Numbers Needed to Treat analysis which looks at reducing just one case of corneal decompensation which demonstrated that it is not cost effective. Thus the conclusion was that it needs to get a whole lot cheaper.
Capsulorhexis
Dr Vote also presented data about the very rough appearance of the laser cut edge when viewed under an electron microscope and compared it to the relatively smooth appearance of manually created ones. The implication here is that this may translate to an increase, anterior capsular tear rate. This however has not been shown clinically so is merely supposition.
Clinical videos
A number of femto surgeons presented video of their femto surgeries, giving us their clinical pearls.
Conclusions
There where really not conclusions with just as many surgeons arguing for as against with really no one changing their positions
My Impression
I have also not changed my position and like many others argue that THE only argument against it is purely cost. There is no doubt that it is more advanced and safer surgery and will with time dominate cataract surgery around the world. Prices will fall and the discussions will come to an end. I also believe, as do others, that the technology needs to change and become more integral with our current equipment, to eliminate the moving of patients from one room to another. It needs to be part of the phaco equipment or part of the microscope