FEMTO FACTOR

The first step in evaluating FSL cataract surgery

Decision-making should embrace clinical outcomes more than time and money.

By Scott LaBorwit, MD

Editor’s note: Scott LaBorwit, MD, of Select Eye Care, a two-location practice in suburban Baltimore, recently purchased a second femtosecond laser for his practice, which is in a market with multiple femtosecond lasers. He has performed more than 1,500 femtosecond cataract surgeries over the past two years. He is also an assistant professor, part-time faculty, at Wilmer Eye Clinic. Every other month he will share business-building strategies for femtosecond laser surgery.

Deciding the right time to commit to the evolving technology in cataract surgery may be one of the most challenging career decisions a surgeon will confront. Decision-making involves integrating the clinical benefits along with the business of medicine all at once. The commitment to the technology involves a long-term financial obligation, not a “toe-in-the water” gesture to see if it is a good fit.

More than two years ago, before I bought my first femtosecond laser, I recall flying across the country with my arms crossed the entire flight with my goal to get enough information to explain to patients and referring doctors why I did not need this new technology to perform cataract surgery.

To my surprise, after I evaluated the technology, I felt obligated to offer it to my patients. I knew if a family member were having surgery, I would find a surgeon using this technology.

Specifically, I felt that the computer integrating the OCT image of the cornea and lens to deliver a consistent and precise treatment would enhance the predictability of the surgery and allow me to evolve my technique to deliver better outcomes.

PRINCIPLE 1: TIME

Business decisions often involve two basic principles: time and money. Regarding time, many cataract surgeons are concerned the technology will slow them down significantly. Using the new technology requires a second procedure where you perform the laser treatment and then do the cataract surgery in the operating room. The laser does not necessarily cut time for the actual surgery.

The question of time becomes concerning. In theory, you may need to cut a day of cases in half compared to traditional cataract surgery volume. However, structuring OR flow to allow you to perform the femtosecond procedure between cataract case turnovers maintains efficiency. With this, I can perform 18 cases by 1 p.m. in a one-room OR, maintaining efficiency and volume.

PRINCIPLE 2: MONEY

Regarding the principle of money, purchasing a femtosecond laser for cataract surgery becomes a big commitment. Often the loan is over five to seven years. Adding all the numbers together including cost of the laser, cost per patient for the patient interface and service contract, the total cost typically is near $1 million over the seven years.

Broken down monthly, a center needs to do a little less than 20 femtosecond laser procedures a month over those five to seven years to break even. Most surgeons report that 20% to 25% of patients when presented with the option choose laser cataract surgery. I was surprised that over the last 22 months of using the technology, 65% of my patients chose femtosecond laser cataract surgery, significantly offsetting the capital expense of the laser purchase while improving clinical outcomes.

MORE THAN TIME AND MONEY

However, making a major decision such as purchasing a femtosecond laser involves more than time and money. You need to prioritize how this technology impacts your clinical outcomes.

At this point, the first question should be whether you truly believe femtosecond laser cataract surgery is best for your patients. Time and money are important, but they should be secondary to the clinical impact. Putting the patient first and focusing on outcomes should be the primary goal and drive the decision-making of when you and your practice are ready to take the leap into laser assisted cataract surgery.

GET OUT AND SEE IT

You should personally evaluate the technology to determine if it will benefit your practice. A video of laser cataract surgery only shows you so much. I can’t tell you the one reason to consider the technology since all the pieces fit together, and sometimes a specific case highlights certain attributes of the laser.

It is fun to watch surgeons visiting the OR to observe laser cataract surgery cases for the first time. They expected to see the laser part of the cataract procedure but didn’t realize the impact it has on the surgery in the OR, patients’ enthusiasm having laser cataract surgery and the ease with which this technology can be integrated into an already busy surgical day. This realization is important in the decision-making process — not just to order the machine, but to ultimately easily and genuinely recommend this technology to your patients and referring doctors.

Like any major decision, you must analyze a number of factors and properly evaluate many facets of the technology. But once you take this leap and commit to femtosecond technology, you will be surprised at how easy it is to integrate into your practice. OM

Scott LaBorwit, MD, is a principal at Select Eye Care, with locations in Towson and Elkridge, Md., and is an assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com. Disclosures: Dr. LaBorwit is a consultant to and speaker for Alcon.