A Look at the Latest in Ophthalmic Lasers

Lasers are powering numerous procedures at eye surgery centers — cataracts, glaucoma, astigmatism, cornea and retina among them — with more on the way. We spoke to experts at high-volume eye surgery centers, all of whom shared tips and gave rave reviews of laser technologies. Here are some aspects of the laser eye treatment space they say you should consider.

John DeStafeno, MD, an anterior segment specialist at Chester County Eye Care in West Chester, Pa., says his center uses lasers for cataracts and corneal treatments, as well as to polish behind cataract lenses to eliminate posterior opacification (secondary cataracts). He says lasers make his surgeries more predictable. "The lasers are very precise and much more accurate," he says. "If you want [a cut] to be a certain size or depth, you can control that much better than if you used blades or other instrumentation."

Bruce Saran, MD, focuses on posterior segment procedures at Chester County Eye Care, and uses lasers for nearly all of them — retinal tears, panretinal photocoagulation to prevent retinal detachments, poor blood flow and treating leaking blood vessels. "In terms of a profit center, having an intraoperative laser for retinal surgery is a very positive thing," he says. "It's better for the patient, it's better for the surgery center. It's good medicine, and it's good business."

At Zion Eye Institute in St. George, Utah, surgeons use the same YAG laser for posterior capsular opacities, vitreolysis for breaking up floaters, selective laser trabeculoplasty (SLT) and peripheral iridotomies, says administrator Zachary Cox, COE. Mr. Cox says Zion's most profitable laser procedure is the YAG laser capsulotomy: "It's so quick, the post-op [recovery] is very easy, and it's a lot safer."

One surgery for which Zion doesn't use a laser, though, is cataracts. "We found there's no benefit to the patient," says Mr. Cox. "All it does is make the surgery a little bit easier for the surgeon."

Other centers, however, fully embrace laser-assisted cataract surgery. Dr. Ondrias cites its clinical benefits — a "little less" corneal edema, a "perfect" capsulorhexis and a "little quicker" visual recovery, less phaco energy used in the eye, and less fluid needed to irrigate and aspirate the lens.

Paul Mann, MD, of the Mann Eye Institute in Houston, Texas, says lasers make capsulotomies much less tricky, adding that they place less physical stress on the surgeon. "Lasers may add 5 years to someone's career if they want to continue operating," he says.

For physician-owners, says Mr. Cox, it's more profitable to have the surgery center buy the laser. For non-owners, he says, the fixed and recurring costs of acquiring their own laser don't add up. "When you have an ASC do it, the surgeon will get a portion [of the reimbursement] that's not that much less," adds Mr. Cox. "You're discounting your professional fee a little bit, but you make up for it because you don't have to put up the money to pay for the laser and the upkeep."

Dr. DeStafeno is excited about the possibility of using lasers to shape an implanted lens after cataract surgery. "It's almost like fixing eyeglass prescriptions by using a laser to reshape the lens," he says. "We wouldn't need to rely on older technologies to try to approximate how well someone can see. If a patient is having a hard time seeing after cataract surgery, we can say, "We can fix this for you and get as close as we can.' Then we try to hit the bullseye by using a laser to adjust. To me, that's going to be the biggest advancement — being able to tweak the patient's vision after the procedure. And it's a really easy procedure to do."

Lasers can also set you apart from the competition. "Patients view lasers as state of the art," says Dr. Saran. "When they hear you'll be using the laser during their procedure, I think it increases their confidence and peace of mind. They look at your facility as more technologically savvy."

Says Dr. DeStafeno, "Patients gravitate toward lasers. They feel like they're getting a higher-level technology procedure. The satisfaction rate for patients with lasers in our field is incredibly high, not only for cataract surgery, but for clearing up behind the lens, and refractive surgery. Studies have shown satisfaction rates in the high 90s for most laser procedures."

When it comes to adding the technology, Dr. Mann says it best: "We got lasers, and we've never looked back." OSM