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Spotlight on the LenSx Laser Are you ready for femto? Practice considerations for the LenSx Laser By Scott LaBorwit, MD cost. It was an expensive purchase, so looking at it over time and creating a business plan made it much easier for me to incorpo- rate financially. Since this technology was very new at the time and I was buying a laser alone, I knew it was a possibility to lose money for the first few years. It also required more time and space. I had to go to a second room and do a pro- cedure before my cataract surgery. My answer to other ophthalmologists' ques- tions about my purchase was simply that I believe it's better and worth it for my patients. In the 4.5 years that I have had the laser, 68% of my cataract patients have cho- sen the laser technology. In a one-room OR, I can do 25 cases in a day, and 18 of them are typically laser cat- aract patients. I have been able to create efficiency in the OR to not significantly compromise my volume while still delivering what I believe to be better tech- nology and surgery. It was also important to bring this into the office and make sure my staff didn't feel burdened with another layer of discussion and more testing. The initial step was to bring them into the surgical center and have them observe the technology first-hand. We included our front desk people, our billing people, and our referring doctors. It had a tremendous impact. Everyone was excited, and we wondered why we didn't do that even sooner. I was concerned about how to speak to my patients about the technology, especially since it was an out-of-pocket expense. I really put a lot of thought into it. I explain the tech- nology and how it may help manage some levels of astigmatism, and I make a personal recommendation for it because I do believe in it. I explain that I can do traditional surgery or I can use the laser before going into the operating room to do key steps of the opera- tion. Along with making a personal recommendation, I also decided that I wanted to discuss risks and bene- fits of cataract surgery. I did not want to discuss price or ask patients if they wanted to do it or not. I wanted to preserve my relationship with them while offering this technology. My surgical scheduler reviews the price and then asks them if they want to use this technology when they are having sur- gery. In the end, I am giving patients an opinion regard- ing the technology, but I'm empowering them to have the information and make the decision on their own without any pressure from me. Learning curve There is a learning curve when incorporating this technology into your prac- tice, but it's more about how to talk to patients, getting your staff on board, and making sure patients understand the technology. I found there is a minimal learning curve in the oper- ating room, because it just enhances your ability to do surgery. It doesn't change any of the steps of the pro- cedure. If the capsule is not completely cut, you can still use the Utrata and finish it. If the cataract is not com- pletely cut, you simply use more ultrasound. This gives you confidence that you can still have a successful sur- gery while you are using the technology. In our practice, due to its precision, laser cataract surgery contributes to 94% of our patients being spec- tacle free for distance ac- tivities such as driving. We share these statistics with them preoperatively. There are many cases in which I am glad that the capsule was treated by the laser, because I believe there is improved safety with this technology. These include difficult cases, such as trau- ma or pseudoexfoliation, and patients with very dense lenses or small pupils. Since I started using the LenSx Laser 4.5 years ago, I have not had to use iris hooks or rings in any cases. It has helped to enhance my outcomes, certainly in managing astigmatism. Choosing a laser There are many choices of femtosecond lasers. When I chose the LenSx Laser initially, my decision was based mostly on what the laser could do and FDA clearance. The second time I purchased a laser, there was more competition, and it was important to look at not just the laser's delivery, but also at important other factors, such as the health I f you are considering adding laser cataract surgery to your practice, it is important to do your homework. Surgeons have an obligation to their patients to really assess the technology before deciding. This requires visiting an OR to actually see the laser being used and to understand the impact in the operating room. Addi- tionally, discussing cases and outcomes can elucidate the impact it can have on astig- matism management and the patient experience. Five years ago, I flew from Maryland to California to as- sess the technology. My plan was to understand it well enough to be able to tell my patients why I didn't need a laser to do parts of cataract surgery. Cataract technology had come so far in the past 10 years that I didn't feel like we needed more. After I saw the technology, it was a long flight home. I realized that there were advantages to using the imaging and the technology to benefit my pa- tients. So, it started with me believing in the technology and wanting my patients to have the opportunity to have this technology as a part of their surgery. Then, I had to figure out how to afford it and how to incor- porated it into my practice. Overcoming obstacles The first obstacle was the

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