The Pros and Cons of Femtosecond Laser-Assisted Cataract Surgery

The Pros and Cons of Femtosecond Laser-Assisted Cataract Surgery

Cataract surgery is one of the most frequently performed operations all over the world, with around10 million procedures completed annually.

As advances in technology continue, more and more ophthalmology clinics are adding laser-assisted surgery options to their equipment and service portfolios.

This opens the door to less-invasive, but more expensive procedures being available to a considerably larger population. It also makes it prudent for patients and professionals alike to consider the benefits of femtosecond laser-assisted cataract surgery (FLACS), which we will discuss today.


The Road To Laser-Assisted Surgery

With historic reference to cataract surgery stretching back as far as the ancient Egyptian, as well as Roman and Indian physicians, the path from couching to femtosecond laser-assisted cataract surgery may not have been the fastest route, but it has certainly followed a logical trajectory.

The biggest innovation prior to the advent of laser-assisted surgery was phacoemulsification, introduced by Charles Kelman in the late 1960s.

Phacoemulsification reduced hospital stays and potential complications associated with cataract surgery tremendously. The development of laser technologies suitable for use in eye surgery began in the 1970s, and as the tools have improved, procedure times have decreased along with complication rates.

The femtosecond laser-assisted cataract surgery we know today is the culmination of advances in laser technology, evolution of techniques and historic wisdom gathered by the ophthalmological community.

Benefits Of Femtosecond Laser-Assisted Cataract Surgery

The key differences between FLACS and phacoemulsification operations is the precision with which they can be carried out – this means a boost to procedural efficiency and effectiveness.

Having access to the latest technology has a certain cachet, and for some being able to access leading-edge expertise makes a big difference to their decision regarding FLACS.

For professionals, the perks of adding FLACS to your clinic can be wide ranging, including:

Increased market reach: femtosecond laser operations can attract a different patient demographic, and also help surgeons upsell premium IOL’s.

More accurate arcuate incisions: Most doctors agree that 90% depth into the limbus is the optimum incisional depth to get maximum correction from arcuate incisions. These lasers allow accuracy that is far higher than any manual cutting instrument.

A perfectly centered capsulorhexis: Femtosecond lasers have the ability to perfectly center the capsulorhexis, and make the cut in the capsular bag a perfect circle which is typically beyond what a human is capable of.

Adjustable wound architecture: Femtosecond lasers allow customizable incisions that would be impossible with manual cutting tools. An example is a phaco incision that has a smaller external width compared to the internal corneal width. This gives the surgeon less wound leakage, along with a greater range of motion with the phaco tip.

Lower phaco energy used: FLACS procedures reduce the amount of phaco energy used during the case due to already having the nucleus separated into “cubes” by the laser. This reduces the trauma caused to the eye during phaco, leading to a quieter eye.

Ongoing skills development: with evolving technology, you are able to find new challenges and skills to develop on a regular basis, though this is less often flagged as a perk of investing in FLACS equipment, the benefit of being able to keep improving your skill set is worth mentioning.

Drawbacks Of Femtosecond Laser-Assisted Cataract Surgery

While the benefits of FLACS can be tremendous, that doesn’t mean the procedure is without potential drawbacks for patients and professionals alike.

For professionals, the majority of drawbacks are related to the learning curve involved in bringing femtosecond laser-assisted cataract surgery in house.

Some of the key points professionals should consider include:

Getting up to speed: More than the initial coursework, you will need to set aside dedicated time to learning how to work with the laser in your office. This includes everything from where to set up the machine to how your support staff can best assist with the FLACS procedures you’ll soon be taking on.

Workflow impact: While it is true that adding FLACS as a string to your clinical bow can provide bolstered efficiency and open the door to more patients, there are logistical hitches you need to think through to avoid treatment bottlenecks in your practice.

Startup cost: Again, the benefits overtime seem to show a boost to turnover as your market reach increases, but femtosecond laser equipment comes with a hefty initial outlay.

Increased case time: In most centers it’s not possible to set the laser up in the same room as the phaco. This means the patient must first be docked with the laser, and then moved to a separate room to commence cataract surgery. This adds extra minutes to your average case time.

Becoming too reliant on technology: One fear with all types of technology is losing the ability to perform on a high level when the technology is not present. This is no different with cataract surgery. Leading to the importance that the surgeons maintain their manual surgical techniques in the event that they do not have the resource of a femtosecond laser system for cases.

Seeing The Future

The shift toward FLACS procedures in clinics around the world is still in its infancy – as more clinics implement laser systems, what the future holds for patients and practitioners interested in femtosecond laser-assisted cataract surgery will come into much sharper focus.

The likelihood is that costs will reduce overtime, and clinical efficiency will continue to rise, yielding lower consumer costs. Additionally, because the FLACS technology itself is still evolving, there arepotential benefits to the treatment that have yet to be discovered.

Deciding whether FLACS is the right procedure for you – or your clinic – is ultimately about balancing a number of factors.

Discussing the options, as well as specific risks and benefits with your care team is the best way to make your determination.

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