The OSNE300 Survey
The OSNE300 Survey is a group of 300 European surgeons regularly polled for their opinions on hot topics in ophthalmology. The surveys are sent monthly, 10 times a year, to those on the list. If you do not receive the survey and would like to be included, please contact Managing Editor Erin L. Boyle at firstname.lastname@example.org
With the added cost of introducing cataract surgery to femtosecond technology, do you think femto-phaco is a worthy investment for practices in Europe?
Diego De Ortueta
With the phacoemulsification technique, we have a safe and effective method to perform cataract surgery. The intraoperative complication rate is very low and the results are also very good. Femto-phaco is a promising technique. Some of the steps, such as the capsulorrhexis, the tunnel incision or corneal relaxing incisions, are more reliable and we can perform them in the manner that we have calculated preoperatively. It seems a problem that in hard lenses we will continue to need to use phaco.
So we have a machine that probably could substitute for phaco in the future, but at the moment there are no proven results that demonstrate that the surgery is more effective. There is also a problem in the working flow of the surgery team. In a high-volume practice, a single surgeon can easily perform four to five phaco surgeries per hour. In the case of femto-phaco, as we need also the phaco machine, we lose time changing from one machine to the other. The solution with a technician is also controversial because we have one more person in the theater room and we give responsibility to someone who cannot manage complications.
So first, we must demonstrate that femto-phaco is really better than the phaco technique, then see the increase in time and cost and evaluate if the procedure is the better option for us, the ophthalmic surgeons.
At the moment there is no proven data that femto-phaco is the better option to perform cataract surgery so any price that we are paying is to obtain data from our own patients, experimenting with them. As long as we are in this stage, we cannot ethically try to sell this surgery as a premium surgery; it is still experimental.
From the marketing point of view, it will be interesting to be the first using the femto-phaco, but it is still a high-cost toy.
— Diego De Ortueta, MD
Medical Director and Chief, Aurelios Augenlaserzentrum Recklinghausen,
Disclosure: Dr. De Ortueta has no relevant financial disclosures.
How could ophthalmic practices offset the cost of introducing new technologies in a down market environment?
When very fast trains were conceived, not only were new engines considered: New tracks, new railway stations, and higher costs for consumers were also the price to pay. As with these trains, a global change in our surgical practice is mandatory.
Does the same femtosecond laser machine have to cover needs for both refractive and cataract surgery?
Which operative theater architecture will optimize femtosecond laser use? Should the laser be used in one or several rooms? That is, will the laser be in a central position, doing the incisions with the rest of operations being performed in nearby rooms?
If the laser has to serve several rooms, how many rooms are necessary?
How many surgical procedures are necessary for an acceptable femtosecond laser cost? Done by how many surgeons?
Which percentage of patients in a given practice could afford the extra cost (laser surgery plus a so-called premium IOL)?
Are currently available machines at their final development stage? Will it be possible to upgrade them at no or small cost?
These are just some of the questions to be answered before considering the femtosecond laser purchase.
Combining surgical efforts to achieve a global revolution will certainly be more useful than seeking government funding in a down market environment.
— Philippe Sourdille, MD
OSN Europe Edition Editorial Board Member, Paris
Disclosure: Dr. Sourdille has no relevant financial disclosures.
Tobias H. Neuhann
1. Is there a reason for the down market environment? If yes, why and can we change it, because the baby boomers are now getting cataracts or asking for refractive lens exchange.
2. Ophthalmic practices can share a femto-phaco in one outpatient surgery center or hire a mobile femto-phaco device. Sharing costs will increase the income and lower the risk of too early an investment.
— Tobias H. Neuhann, MD
Disclosure: Dr. Neuhann has no relevant financial disclosures.