Laser-Assisted Cataract Surgery: The Next Steps?

Roger F. Steinert, MD


March 30, 2016

The use of femtosecond lasers in cataract surgery is still controversial. While many surgeons continue to hold back, uncertain whether the costs and benefits make sense, a significant number of cutting-edge surgeons have taken the steps to make laser-assisted cataract surgery a part of their standard surgical approach.

In the United States, the majority of surgeons use a combination approach, whereby they first use the laser and then perform the remaining portions of the cataract surgery using conventional manual techniques.

What is still the rule is that a single surgeon performs the entire procedure. The surgeon may use a single operating room in which both the laser portion and the manual portion of the procedure are performed, or the surgeon may use two different rooms—the laser portion is performed in a room immediately next to the operating room, in which the manual portion of the procedure is then performed. Some surgeons may even have two operating rooms and one laser. The choice between these approaches is usually driven by the setup and the ability to use two operating rooms as opposed to a single operating room.

In a most extreme example, some surgeons are able to use a single operating room table, first using the laser and then simply switching the position of the table to finish the manual portion of the procedure.

A newer approach is to consider using two surgeons: One performs the laser portion and the other performs the remainder (the manual portion) of the surgery. This has the potential advantage of making the entire procedure more efficient, and the extra cost of two surgeons is offset by this more efficient approach.

A number of issues regarding this newer approach have yet to be resolved, such as:

  • Full consent;

  • Reluctance of surgeons and the intrusion on the doctor-patient relationship;

  • Financial barriers; and

  • Potential backlash from patients who feel that the surgeon has become a distant mechanic rather than a "captain of the ship."

It will be interesting to watch how this possible shift in surgery plays out over the next several years.


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