Eyeworld Daily News

EW SHOW DAILY 32 T he ethics of femtosecond laser-assisted cataract surgery was addressed in a course instructed by Richard S. Hoffman, MD, Eugene, Ore., with John D. Banja, PhD, Atlanta, Donald N. Serafano, MD, Los Alamitos, Calif., Michael E. Snyder, MD, Cincinnati, Sonia H. Yoo, MD, Miami, and Abhay R. Vasavada, MS, FRCS, Ahmedabad, India. The surgeons spoke about how they would deal with specific scenarios involving femtosecond cataract surgery and what they would recommend for patients. The first scenario was a patient who comes into a practice on the recommendation of a friend on whom the doctor has previously per- formed a successful cataract surgery. This patient wants cataract surgery with the femtosecond laser, but the doctor does not perform this or have access to the laser. Audience mem- bers said they would mainly refer to another doctor or try to talk the patient out of the procedure. Dr. Serafano said experience with the femtosecond laser will make the discussion with the patient easier. As physicians use it more, they begin to realize the patients who will benefit the most from it. Dr. Yoo would argue that you could never say that using the laser is a medical necessity. "You can do cataract surgery without this device," she said, so you have to factor in if and how the decision would benefit the surgeon. Another case that was discussed involved a surgeon who believes the femtosecond laser is superior to standard cataract surgery. The panel was asked what they would do for a simple cataract patient who wanted the femtosecond laser with with a standard monofocal lens and a perfectly spherical cornea. Dr. Vasavada said that he would tell this patient about having to pay extra, and if the patient is comfort- able with that, he would do it. He believes the safety of the fem- tosecond laser is a bigger indication than the precision at this point. Dr. Hoffman pointed out that in the U.S., it's a pseudo-ethical dilemma because surgeons are not allowed to use the laser on a patient who's not a candidate, and it can't be used even if asking patients to pay the extra cost. Panelists were asked if they believe that femtosecond laser cataract surgery will make enough of a difference in outcomes over the next decade that ophthalmology practices will feel duty bound to purchase or rent a machine. Dr. Serafano said the technology is still relatively new, and the num- ber of lasers and surgeons using it is starting to increase. He believes the answer to this question will become more apparent as the years go on. There is evidence that it de- creases the amount of phaco energy; however, the question to answer is whether it actually improves visual outcomes, Dr. Yoo said, adding that this will be difficult to determine because it involves evaluating how critically you have looked at outcomes prior to starting the laser, and there are many variables that would arise in a study like that. EW Tuesday, April 29, 2014 Meeting Reporter Femtosecond laser questions discussed at ethics course by Ellen Stodola EyeWorld Staff Writer Dr. Hoffman moderates the "Ethics of Femtosecond Laser Cataract Surgery" course.

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