As I See It

Do Femto Cataract Boosters Go Too Far?

Enthusiasm is fine. Irrational exuberance isn't.

By Paul S. Koch, MD, Editor Emeritus

We are all inundated with so many things to read — peer-reviewed journals, non-peer-reviewed journals, trade newspapers, marketing and promotional materials — that it's sometimes hard to decide where to start. After spreading out all the deliveries across the desk, we have to decide which we should read, which we should put aside and, unfortunately, which could give us a good laugh.

While we all want to stay abreast of the latest developments in our specialty, sometimes we come across things that do not pass the giggle test. If we can't get through a publication without chuckling, that's a pretty good sign that maybe it should have gone back to the drawing board instead of the press.

Right now I have on my desk the report of 21 European Union scientists who were asked to rule on whether water could reduce dehydration. That's right, they were asked whether water could reduce a shortage of water in the body. The eminent scientists ruled that drinking water does not ease dehydration. According to the Daily Mail, they ruled that shortage of water in the body was just a symptom of dehydration, not dehydration itself.

As the inhabitant of a body that's moonlighting as a kidney stone farm, such body being over the age of, oh, I don't know, six, I can pretty much assure our readers that water does reduce dehydration. Who knows what madness caused the scientists to rule otherwise — no doubt due to some obscure technicality — but as for the ruling, I giggled and decided I do not believe it!

Counterintuitive Claims

Before our last major convention, I received several advertisements telling me that I needed to improve my efficiency in cataract surgery by using a femtosecond laser. The promotion's goal was to convince me that taking a patient to a laser, doing a treatment, then taking the patient to the operating room and doing some more treatment is going to be more efficient than just sitting down and getting the work done. I say to the company: do what you want with your business, but if I were you I'd gently redirect the person who thought up that campaign. The premise of the campaign did not pass my giggle test and I decided that I do not believe it!

I also have a peer-reviewed article by excellent scientists telling me that, in their early laser cataract surgery cases, they popped two posterior capsules and dislocated the cataracts. That does not bother me. It's a new technology and there will be a learning curve.

The early adopters enjoy venturing into the unknown to develop a technology that will make it safer for you and for me. But when I go to a meeting and I am told that right now, today, before all but one laser even makes it to market, laser cataract surgery is better/safer/premium or whatever, I shake my head. Perhaps one day it could be, once all the bugs are shaken out, but making such claims based only on very limited trials tells me the advocates have run amok. Let's chalk it up to “irrational exuberance” like they do on Wall Street. Still, I hear those claims and I giggle because I do not believe them!

The Burden of Proof

I have no idea how the laser cataract market will shake out, but I do not see how it could be more time efficient or cost efficient. I do not see how anyone can claim it's better than what we're doing now until we have the experience of many thousand cases in the real world. Claims that cannot pass my giggle test only serve to make me skeptical about the validity of future claims.

There's a lot at stake here, and I caution the companies that are developing this technology that I will have difficulty forming a second first impression. The burden of proof is theirs. Once they lose me, they'll have a hard time getting me to think about their proposition seriously.

I want to see more data so I can form an opinion, and less marketing hype telling me what my opinion should be. OM

Paul S. Koch, MD is editor emeritus of Ophthalmology Management and the medical director of Koch Eye Associates in Warwick, RI. His e-mail is paulkoch@kocheye.com.