As I See It

Where's the Beef in Femto-Phaco Claims?

Overhyped, oversimplified statements trickle into print.

By Paul S. Koch, MD, Editor Emeritus

In this space a few months ago I begged for clinical investigators to provide us with clinical information on the safety and efficacy of laser cataract surgery. I especially want information from surgeons performing the procedure who are not directly affiliated with one or more of the laser companies. I've been around long enough to know how statistics can be adjusted to put one's best foot forward, and I want data from people who did not have a foot in the fight.

A 5 mm round anterior capsulotomy created by a femtosecond laser.

The technology is new and it will be a while before independent results will appear. Until then, we really do not know whether lasers are better, or if they're just different.

I've also been around long enough to remember the wild advertising about cataract surgery that took place in the 1980s. Claims such as “Free!” “Painless!” “Safe!” and the ever infamous “Five Minutes!” led to our professional organizations taking stands on what constituted appropriate advertising.

Ads are ‘80s Throwbacks

Against this backdrop, I've been reading a number of newspaper ads local surgeons purchased trumpeting their new cataract laser, along with news articles featuring the surgeons who are purchasing the ads. I was curious how they were going to position the procedure versus what they were doing previously.

This from a print ad: “Predictable Outcomes.” If they mean the patient is predicted to see better after cataract surgery than before, they're right. Most do. But, if they mean the postoperative refraction can be predicted in advance, I'd want to see evidence that the normal Gaussian distribution of postoperative refractions disappeared. I've seen nothing to convince me that a laser capsulotomy compensates for the normal range of refractive results.

From a print ad: “This is the most significant improvement in cataract surgery in the 40 years I've been treating surgical cataract patients.” Really? That takes us back to 1972. I guess the surgeon feels that a laser incision and capsulotomy is a greater revolution than phacoemulsification, intraocular lenses, topical anesthesia or YAG capsulotomies. I do not agree.

From a print ad: “Now my cataract patients have the same choices for independence from glasses as my LASIK patients.” That's not far from the truth and I won't quibble, but it's not the laser that does it; it's the incredible range of excellent and modern intraocular lenses that we all use that gives us so many options.

Science Shrugged

Articles get a wider berth, because newspaper writers have a lot of leeway in interpreting what they hear, how they understand it, and how they try to relate the message to a lay audience. An example edited for space: “The laser cuts a perfect circle that's precisely centered … that frees the surgeon to (use) a multifocal artificial lens. Patients who get a multifocal lens … can ditch their glasses after the laser procedure.” No! They can “ditch” their glasses after getting a multifocal lens, not after the laser procedure.

Another article: “The laser surgery … reduces the risk of damage to the cornea.” I'm not sure that's ever been proven, but I have heard of a few cataracts that have been dropped into the vitreous because of the laser. Ah, the adventures of being an early adopter.

If you spend a lot of money on a new laser and want to advertise for patients, I would, too. And if you want to exaggerate a little bit, well, that's what advertisers do. I only ask that if you want to shout the benefits of your laser, you have some clinical results to base them on, and not rely on the hopeful promises of the guy who cashed your check. 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.