Eyeworld Daily News

55 EW SHOW DAILY ASCRS•ASOA Symposium & Congress, San Diego 2015 by Rich Daly EyeWorld Contributing Writer surgeons to create a surgical plan— including the type of laser pattern that will be used to break up the cataract—prior to the procedure. EW Editors' note: This event was supported by educational grants from Alcon (Fort Worth, Texas), Bausch + Lomb (Bridge- water, N.J.), LENSAR (Orlando, Fla.), and Sightpath Medical (Bloomington, Minn.). E merging evidence of a sharp clinical improvement from the use of laser-assisted cat- aract surgery (LACS) could soon drive a sharp increase in use. Although only 5% of ophthal- mologists used LACS technology in the fourth quarter of 2013, accord- ing to financial research firm Market Scope, attendees at a packed EyeWorld CME Educational Sym- posium on LACs indicated plans to increase use. Specifically, 37% of attendees polled said they planned to use LACS in the next 12 months, while 29% said they already used it. "That would be pretty extraor- dinary growth, and we will watch to see whether that happens," said Richard L. Lindstrom, MD, Bloom- ington, Minn., said at the event, "Step by Step: Clinical and Practical Implementation of Laser-Assisted Cataract Surgery." The possible increase would be a sharp rise from the findings of the 2014 ASCRS Clinical Survey, in which ophthalmologists reported that an average 5.8% of cataract surgery patients received LACS. Surgeons' hesitancy to use the technology was driven by reim- bursement and financial concerns (61.7%), lack of access to the tech- nology (32.7%), and lack of clinical data showing benefits (35%), accord- ing to the survey. Surgeons who have examined the finances of the systems offered a range of insights on ways to afford the technology. "Realize that this is 'premium surgery' with patient shared respon- sibility in the cost as you look at your own practice; to really make this make sense you have to implant 50—or preferably 100—toric, multifocal, or accommodating lenses per year," Dr. Lindstrom said. However, physicians who im- plant 50 to 100 premium lenses in cataract surgery each year could uti- lize LACS in a financially sustainable way through a shared access model. David M. Dillman, MD, Danville, Ill., joined a shared access arrangement in 2013 after he con- cluded he could not afford to buy the laser system and no lasers were available for him to use in his area of the state. Surgeons who utilize a mobile laser program can forgo the cost of purchasing a $550,000 system, but they still must financially commit to performing a specific number of cas- es quarterly; performing a minimum number of cases on each OR day; paying for the mobile docking de- vice for each case; paying a user fee for each case; and paying a penalty for not meeting contractual quotas. "There is still a commitment with mobile but nowhere near the commitment of buying one of these lasers," Dr. Dillman said. "The mo- bile laser program made this tech- nology very doable for me." Participant surveys at the symposium showed a significant increase in perceptions of clinical improvements from the use of LACS. Specifically, those seeing a signifi- cant clinical benefit increased from 41% at the beginning to 61% by the end. Some of the biggest improve- ments over standard cataract surgery that attendees identified following the symposium were in refractive incisions and in lens fragmentation. Robert J. Weinstock, MD, Largo, Fla., described some of the more than 80 published studies on the efficacy of LACS over standard cataract procedures. Superior results have been identified in the ability of LACS to pre-chop and pre-crack the nucleus, while reducing the use of ultrasonic energy and easing nuclear disassembly. Results have included a reduction in endothelial damage and capsular tear. "I looked at all 3 laser platforms available using fragmentation and all have shown a statistically signif- icant reduction in phaco time by using fragmentation for the cataract removal," Dr. Weinstock said. Among Dr. Weinstock's clin- ical pearls for LACS systems is for Sharp increase in LACS coming? Dr. Weinstock advises surgeons using LACS systems to create a surgical plan prior to the procedure. Now live at www.EWrePlay.org

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