Tips for Integrating the LenSx Laser Into Your Practice

Learn how these new users quickly got up to speed.

By Virginia Pickles, Contributing Editor

It's one thing to hear early adopters tout the benefits of new technology from the podium, but quite another to decide it's time to integrate it into your practice. Promises of outstanding outcomes notwithstanding, practical concerns and questions arise. We spoke with two surgeons who believe the femtosecond laser will figure prominently in the future of cataract surgery. They researched their choices, crunched the numbers and decided the LenSx® Laser (Alcon Laboratories, Inc.) would meet their needs now and in the future. In this article, they discuss why they chose the LenSx Laser, how they successfully incorporated this technology into their practices and tips for a smooth transition to laser cataract surgery.

Why the LenSx Laser?

Advanced technology with multiple FDA clearances, along with a supportive, forward-thinking manufacturer made the LenSx Laser the front-runner for the surgeons we interviewed. "When we started looking at femtosecond lasers, we recognized that the LenSx Laser had the most FDA clearances. It's cleared for anterior capsulotomies, corneal incisions and phacofragmentation," says Ryan P. Conley, DO, a partner at Triad Eye Medical Clinic and Cataract Institute, Tulsa, Okla. "In addition, having used Alcon pharmaceutical and surgical products, we knew the company provided excellent products and support." According to Dr. Conley, the company installed the laser promptly and efficiently and provided in-depth education, not only certification training for the surgeons but also important information for technicians, counselors and office staff.

"Alcon's commitment to the femtosecond laser market and its willingness to deploy resources to support this platform were key factors that influenced my decision to buy the LenSx Laser," says Ivan Mac, MD, MBA, founder of Metrolina Eye Associates, Monroe, N.C. "An engineer is always available to us, and the company's marketing staff has been extremely helpful. I also benefit from the company's quarterly LenSx Laser users meetings, where I can network and share ideas with other surgeons."

Both surgeons believe the LenSx Laser platform will form the basis for future advancements in femtosecond technology. Dr. Mac notes, "Alcon has developed an image-guided surgery system called VERION™ image system which takes a picture and measurements of the eye in an undilated state, and populates the image and data into an advanced planning software program that allows the surgeon to plan each detailed step of their procedure at a single source. This case file may then be transferred via USB stick to the LenSx Laser to auto-align our pre-determined plan for that patient's incision and arcuates. It automates all of our preoperative steps. The company doesn't just say, 'Here's a femtosecond laser, and look what it can do.' It shows us what the future will look like with new components that will help us continue to enhance our outcomes."

Up and Running Efficiently

Patient flow is key for efficiency in the OR. In just 3 months, Dr. Mac and his team have integrated the LenSx Laser into their surgical routine and patient flow has become "seamless." Because of limited space, they've placed the unit in their OR.

"One of the benefits of the LenSx Laser system is that it doesn't have a fixed bed," Dr. Mac says. "Patients are wheeled into the OR on an existing bed and positioned under the laser for that part of the surgery. Then, the bed is swiveled around, and the patient is prepped for phacoemulsification and lens implantation. It's a patient-friendly set-up because patients don't have to move to different beds. This is a big advantage from a flow standpoint."

Getting the Word Out

As Dr. Conley notes: "You can have the world's greatest technology, but if nobody knows you have it, it's worthless. So we try to spread the word and let people in the community — other ophthalmologists, referring optometrists and potential patients — know what's available." For example, Dr. Conley's practice has provided a local television station with material for its "Medical Minute," and the practice has also bought space in the local newspaper to educate readers about new technology, often correcting misconceptions about laser cataract surgery. "We also hold an annual symposium for eye care practitioners," he says. "Last year, about 200 optometrists from Oklahoma, Kansas, Missouri and Arkansas attended the symposium, where I gave a presentation on the femtosecond laser's role in cataract surgery and showed videos. We also have optometric network managers, who reach out to optometrists in the community to educate them about the latest techniques and technologies." Dr. Mac is still building his referral network, and he's found the LenSx laser is an effective tool to do that. "When an optometrist refers a patient to us for cataract surgery, we invite the optometrist to observe the patient's femtosecond procedure," he says. "The ODs have been absolutely floored when they see how precise and accurate the laser is, and how my patients have had no discomfort during the procedure. They get excited about the technology, because they want the best outcomes for their patients. I believe our referrals have increased as a result."

Space is also at a premium at Dr. Conley's surgery center. In the 16 months he's been using the laser, he experimented with different routines before finding the best way to maximize efficiency. He also has the laser in one of his OR suites and after performing the laser procedure, repositions the patient under the microscope to complete the procedure. "We found it's the most efficient routine. In total, the laser adds 2 to 3 minutes to the operating time. Now that we've refined our patient flow and everyone is well trained, it works like clockwork."

Dr. Mac was also concerned about the time required to use the laser as compared with manual cataract surgery. "We'd heard that the laser slows you down," he said, "but we've gotten it down to a science, so we're adding only 3 to 4 minutes per case. Every surgeon has to develop his own techniques to compensate for the time. I believe 3 to 4 minutes for a potentially better outcome is worthwhile."

Natural Fit with ATIOLs

Both surgeons have been using advanced technology intraocular lenses (ATIOLs) in their practices, and the femtosecond laser is a natural fit for them. "Although my practice isn't located in a wealthy area, our conversion rate to premium IOLs was averaging from 25% to 40%," Dr. Mac says. "So I viewed femto-phaco as the next logical step in the evolution of my practice."

In Dr. Mac's practice, anyone who chooses an ATIOL will undergo laser cataract surgery. The fees for the ATIOL and the laser are bundled. "We increased our fee for premium ATIOLs to include the use of the laser," Dr. Mac explains.

Dr. Mac has been surprised by the number of patients who are choosing to upgrade. "We're seeing about a 60% to 70% conversion to either the femtosecond laser or the femtosecond laser with a premium lens," he says.

Dr. Conley reports that about 99% of patients who choose ATIOLs in his practice have laser cataract surgery. "Unless the laser is contraindicated — in patients with corneal scarring, trabeculectomy or some other glaucoma filtration device, for example — we offer it to all patients who would benefit from cataract surgery with ATIOLs," he says. "Many individuals simply like the idea of a laser creating their incision as opposed to a blade."

Dr. Conley also has seen an uptick in the use of ATIOLs in his practice. "I think word of mouth is partly responsible," he states, "but I also believe our referring doctors are more confident in our ability to offer a more precise procedure. Because of the LenSx Laser technology, I'm delivering better results. I'm getting to the intended refractive target more often. The laser time and laser energy have trended downward with parameter modifications and transitioning to the Softfit™ Patient Interface. Consequently, we're seeing more calm and quiet eyes on post-op day 1."

Top-down Education

Both surgeons emphasize the importance of educating everyone in the practice about laser cataract surgery, and they credited Alcon for providing a comprehensive educational program. "They included our clinical technicians, our front desk staff, our checkout staff and even our opticians," Dr. Mac says. "Since then, to reinforce that education, we've rotated two or three staff members each week into the OR to observe cataract surgery with and without the laser, so they can understand the differences."

Dr. Conley agrees that staff plays a key role when integrating new technology. "After seeing how the technology works and understanding the benefits, our staff members are comfortable discussing laser cataract surgery with our patients," he says.

To enhance their patient education, both surgeons have incorporated video clips supplied by Alcon into their own cataract videos. As for one-on-one counseling, Dr. Mac does most of the counseling himself. "After a patient views the video, I meet again with him, look at the dilated examination and review the studies," he explains. "Then, I describe both manual and laser cataract surgery in detail and the differences between them. I spend more time with patients, but it's definitely higher yield when I have that discussion versus when a counselor has it."

Dr. Mac uses a program on his iPad that shows patients how presbyopia and astigmatism affect their vision and how ATIOLs address those conditions. "I show them side-by-side comparisons of blurred vision versus clear vision with the ATIOLs," he says. "I think seeing what the technology can do for their vision really hits home. Then I always tell patients, 'These are your options. I want you to pick the option that will work best for your visual needs and for your financial situation.' Patients will upgrade. It's just amazing."

Breakeven Realities

With the purchase of any new technology, particularly a big-ticket item such as a laser, concerns about costs, time to break-even and return on investment are always part of the discussion. "Alcon has a business model to help you anticipate what sort of revenue you'll generate and the number of cases you need to perform to break even," Dr. Conley explains. "The company also offers financing. All of the details were laid out in advance for us. In our practice, with two surgeons and a modest increase in conversion, we reached the monthly break-even target in just 3 months."

Dr. Mac's practice also reached the break-even point rapidly. "We thought it would take at least 15 cases a month to break even and that we would run at break even for the first year or so," he said. "Right now, we're consistently performing 45 to 50 cases a month. We've far surpassed expectations. This is the fastest adoption of anything I've ever seen before."

Growth Through Innovation

Both Dr. Conley and Dr. Mac believe femtosecond technology takes cataract surgery to the next level, which in turn has taken their practices to a new level. "It's giving us accuracy and precision that we could never achieve before," Dr. Mac says. "My enhancement rate for ATIOLs is extremely low now, because I'm able to make very precise and reproducible arcuate incisions with this laser. My post-op day 1 patients see better than when I perform the surgery manually. Patients have a faster visual recovery, and they're happier."

According to Dr. Conley, offering laser cataract surgery has revitalized his practice. "Our practice has always been known for innovation in the local community," he says. "So when I joined the practice, I wanted to continue the same trend and add new technology when it became available. Since we began offering cataract surgery with the LenSx Laser, our practice has experienced significant growth."

Dr. Mac offers one additional pearl: "To any surgeon who is concerned about being successful with femtosecond technology, I would say, Don't 'sell' it. Just explain the differences between manual and laser cataract surgery. Patients understand." ▪