Larry E. Patterson, MD is medical director of Eye Centers of Tennessee and the Cataract and Laser Center in Crossville, Tenn., and is past president of the Outpatient Ophthalmologic Surgery Association.
Q: What has been the effect of technology on ophthalmologic ambulatory surgery centers?
Larry Patterson: Perhaps the biggest change was the advent of phacoemulsification for cataract surgery, which took many years to gain acceptance. In the early 1980s, only 15 percent of the cataract surgeons were using this technology. Now everybody uses it. It would be hard to find a new technological change today that will have that kind of impact.
Q: What is the impact of premium intraocular lens implants?
LP: Premium IOLs can make you less dependent on glasses, but they are not going to make you see any better. In addition, multifocal lens implants have certain side affects, such as halos at night, and accommodative implants also have limitations. The extra charge for a premium IOL ranges from $1,000-$3,000. This can include touch-up surgeries or other follow-up for a year afterwards.
Q: What is the conversion rate for premium IOLs?
LP: Nationally, somewhat less than 10 percent of cataract patients convert to premium IOLs rather than ordering regular IOLs. At my practice the conversion rate has been about 15 percent, but it can range all over the place, from as much as 60 percent in some practices to as little as zero in practices where physicians and staff don't even bring up premium IOLs.
Q: What impact will the femtosecond laser have?
LP: The femtosecond laser is an awesome piece of technology. It means that all corneal incisions can be precut and the capsulorhexis can be made perfectly round at whatever size desired. Without the femtosecond, you have to make it by hand. And finally, the femtosecond can break up and soften the nucleus, so you can remove it faster and with less energy. This causes less damage to the cornea and means there should be fewer complications.
Q: What about the cost?
LP: The cost of the femtosecond laser is an obvious downside. Right now it is around the half-million-dollar mark, though eventually the price might come down due to competition. There are at least four systems that are partially or fully approved by the FDA.
There is one additional cost aspect, however: the use of a per-click fee, an extra payment to the manufacturer each time the device is used. Companies are already charging a per-click fee of $100-$250 for LASIK and the word is that the femtosecond laser may cost several hundred dollars per click.
Q: Will Medicare pay for the additional costs of the femtosecond laser?
LP: Medicare, which covers most cataract removals, currently pays a fixed fee for each procedure that is not enough to cover the extra expenses of the femtosecond laser. In the future, CMS may allow ophthalmologists to charge the patient extra for femtosecond, as it now does for premium IOLs. But in this uncertain reimbursement climate, that may not be possible.
Q: Who is using the femtosecond laser at this point?
LP: Only a few of these devices have been distributed. My impression is the physicians who already have the femtosecond laser either have an investment in the company or participated in the clinical trial to get them approved. The initial expense is huge and the secondary expense is significant.
Learn more about Eye Centers of Tennessee.
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