More compelling evidence needed for femtosecond cataract surgery

There is currently no peer-reviewed evidence supporting the idea that femtosecond-assisted cataract surgery is safer and more effective than traditional phacoemulsification techniques in routine cataract cases, according to a speaker here. 'We know that the femtosecond lasers can be used to create corneal incisions, capsulotomies, and to liquefy and fragment the lens. However, if you look carefully at all these indications there is currently no peer-reviewed data to support the case for doing femtosecond laser cataract surgery,' said George Beiko MD. Dr Beiko noted that femtosecond technology is not the first laser technology that has been used over the years to remove cataracts. 'We have seen various systems and devices such as Daniel Eichenbaum's YAG laser, Jack Dodick's NG-YAG laser and Michael Colbert's erbium YAG laser, all of which have fallen by the wayside and have not stood the test of time for routine cataract cases,' said Dr Beiko. Some of the femtosecond laser systems currently on the market are FDA approved, but none have actually undergone controlled FDA-approved trials, said Dr Beiko. 'All have been approved through a side system which allows them to come into use without any FDA-approved trials,' he said. In economic terms, Dr Beiko said it was very hard to make a compelling case for femtosecond laser use in cataract surgery. 'The cost to our hospital is about $650 for a routine cataract case. That is the direct and indirect cost, including nurses, the hospital and the capital cost. For femtosecond cataract surgery, we add in the cost of the laser, which is typically about $500,000, a maintenance contract which is about $40,000 a year and then there is the click fee of about $400 per case. Depending on the volume of the practice, this works out to a charge between $1500 and $2500 per case, which is a very significant difference indeed,' he said. Taking the example of astigmatism, Dr Beiko said laser correction is possible for the 35 per cent to 40 per cent of patients with astigmatism between 0.75 D to 2.0 D. 'We know that using toric lenses and limbal relaxing incisions is comparable in that range. So you are effectively spending $1500 to $2500 for a technology to do what a toric lens can already do at a significantly reduced cost,' he said.