Archive February 2015 XVI, No. 2

Thinking of Buying ... A Phaco Machine

Is it time to replace your facility's phaco system?

Jeffrey Whitman, MD


phaco machine INTRAOCULAR INSIGHT Ask your surgeons: Do the latest offerings on the phaco machine market radically outperform your current equipment?

Is there still a place for phaco in the age of the femtosecond laser? Short answer: yes. Femto has done nothing to replace phacoemulsification. In fact, the use of lasers to slice and dice cataracts can make phaco even safer and more efficient, since less ultrasound energy is needed to dissolve the material and, as a result, less heat is created in the eye. About 40% of laser cases don't even use ultrasound, they just irrigate and aspirate the pieces.

Given the continued utility of phaco machines as well as the proven durability of these workhorses, should the introduction of an all-new, next-generation system lead you and your cataract surgeons to consider an upgrade?

With cataract facility reimbursements what they are, no one relishes the idea of shelling out 6 figures for a new phaco machine today. But as you'll see in the product roundup over the next few pages, the features on the new machines make cataract removal significantly safer than ever before. Even though you can't charge more per case for cataract procedures in the wake of a capital expense, the new machines can make the procedure more efficient, saving OR time.

Functionally speaking, will the new system work dramatically better than the technology your surgeons are operating with now? If the machine they use is from 2 generations ago, it's definitely possible that fluidics — the manner in which the machine sucks material out as it pours new balanced salt solution in to replace it — have seen some innovations and improvements since then.

Function and economics should also drive any potential purchasing decision when, every few years, you invite manufacturers' representatives into your facility and trial the newest add-ons and tweaks to their phaco systems. I don't think you can go wrong with any of them, but make sure all of your surgeons get a chance to use each system and determine whether they meet their needs. Are the fluidics better than their current equipment? Is the ultrasound more efficient? How about the irrigation and aspiration? A surgeon needs to ask, do I feel safe with the equipment I have? A hands-on trial will help to provide an answer.

SAFER PLATFORMS SAFER PLATFORMS The features on today's new phaco machines make cataract removal significantly safer than ever.

The reality of equipment purchasing today is, deals are done in bundles. If you're thinking of buying a phaco machine, as with other surgical components, it's economically wise to look at the vendor and its other products. Do your surgeons like their intraocular lenses, viscoelastics and other supplies? In many cases, it is easier to negotiate a more favorable price on that purchase from a manufacturer whose products you use in high volume. If your center bought $250,000 worth of their IOLs last year, be sure to let the vendors' rep know.

It will be interesting to see how the next generation of phaco machines accommodate to the use of femtosecond lasers in cataract surgery. The cost of laser technology and skepticism over its clinical necessity have limited its adoption, but it is an advance we can't ignore, and it may be even more common in 5 or 6 years. However, no manufacturer has yet rebuilt a phaco system to truly dovetail with the femto laser — featuring, for example, aspiration and phaco tips that can vacuum up larger pieces. Future phaco advances will have to go hand-in-hand with laser capabilities, and yet also serve the users who haven't implemented laser technology. We'll see.

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