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Archive Hot Technology 2016

Is it Time to Add Laser Cataracts?

Bladeless surgery shows plenty of promise, but it might be years before the technology reaches its true potential.

Daniel Cook

Daniel Cook, Editor-in-Chief


Dr. Hunter Newsom DIALING BACK Dr. Hunter Newsom has limited the use of his laser and now sells his patients on refractice results.

Cataract surgeons are naturally drawn to the allure of using femtosecond laser technology to pulverize clouded lenses and make precise cuts in the anterior lens capsule, and most of their patients want to be operated on with the latest and greatest technology. Is it any wonder that eye centers are sinking hundreds of thousands of dollars into laser platforms that keep them on the cutting edge of care? Should you follow their lead, especially when manual cataract surgery is so safe and so effective? Like most difficult equipment purchasing decisions you face, it depends on the clinical goals of your surgeons, the expectations of your patients and the size of your capital equipment budget.

Cost considerations
Insurers and Medicare don't cover use of the laser, so its per-case cost is passed through to patients who pay out of pocket for premium services that include enhanced refractive outcomes. You need a significant pool of patients willing to pay for premium services in order to recoup the roughly half a million dollars you'll sink into the laser platform.

That means the femto laser is typically used in facilities where several surgeons are working together to keep up throughput, says surgeon Kevin Miller, MD, a professor and the Kolokotrones Chair in Ophthalmology at the David Geffen School of Medicine at UCLA. "In order to afford the laser, you must do volume," he adds. "Otherwise you'll just get killed and you end up eating the cost."

How quickly you amortize the laser depends on how long the system will be functioning and how many patients you operate on during that time. "Eye centers and surgeons don't know those exact numbers when they buy the laser," says Dr. Miller. But they might be able to come up with solid estimates. For example, Dr. Miller knows 85% of his patients will pay $1,400 out of pocket for astigmatism management. Using the laser costs Dr. Miller in time and effort, so he bumped the fee from $1,400 to $1,700. Adding the laser to the package tacks on an additional $800, a figure he negotiated with UCLA administrators. The cost of a premium lens is also $800. That means patients who want laser-assisted cataract surgery must fork over $3,300. Dr. Miller says about half of the patients who are willing to pay for astigmatism management sign up for the laser. He also points out those numbers are specific to the Los Angeles market.

Dr. Miller advocated for years to add a laser, and finally convinced UCLA to make the investment last August. Instead of purchasing the laser outright or securing a loan, the hospital opted for a lease-to-own arrangement with the manufacturer. It was a viable way for the facility to add the laser without a significant capital outlay. Surgeons must perform an agreed-upon amount of cases each month to use the laser. If they fall short of the number, the manufacturer carts the laser away. If they exceed it, the laser stays and a portion of the profits are applied to the purchase of the laser.

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