A Look at the Latest in Ophthalmic Lasers


New treatments and excellent outcomes are just a few of the reasons to add the technology.

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.

Clinical versatility

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."

Useful for cataracts?

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."

PROVEN TECHNOLOGY Patients seek out facilities that offer laser procedures and are reportedly very satisfied with the results.   |  Zion Eye Center

There's also the crucial consideration of reimbursements. CMS, for example, doesn't distinguish whether the surgeon uses a laser or traditional instruments for cataract removal. It's just paying for the removal of the cataract. Considering how you'll cover the extra cost of the laser — you can't charge the patient specifically for the use of the laser during cataract surgery, but you can charge for the costs of surgical correction of astigmatism, a common condition which can be addressed during the same procedure — is instrumental to success.

Lasers can make your center more efficient in terms of block times, says Mr. Cox. "If a surgeon doesn't waste time going inside the eye to open up the capsule and instead uses the laser in a minor procedure room, he can do that while other surgeries are going on."

The more accurate lens positioning enabled by lasers can be a big differentiator for your center, says Dana Ondrias, OD, the CEO of the Mann Eye Institute. "The really sophisticated cataract patients have become more demanding of the [refractive] outcome. It's no longer enough for them to go from not being able to see anything to "I can see something, so I'm happier.'"

Dr. DeStafeno says a smart eye surgery center should have eyes wide open about potential financial pitfalls. "The first thing you have to figure out is, do you believe it's beneficial and a good value for your patients?" he says. "Then look at the business model. Can you bring this technology to your center to benefit patients, but also make it a win financially? It can really hurt a surgery center if you don't figure that out."

Used properly, centers say, lasers can make your facility more efficient. When Dr. Ondrias was evaluating laser technology, she focused on the finer points of pricing, training, implementation and surgeon buy-in, and then on using lasers efficiently. "It's become quite profitable for us," she says. "And that's not why we got it. It wasn't profitable at first. But as we started to use it more and understood how to put it into the flow, and create the outcomes we're looking for, and be able to do a higher volume, it's performed well. It's not a huge upcharge for the facility itself, but it's enough to cover the cost [of the technology]."

Future promise

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

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