FEMTO FACTOR

Critical factors in a femto laser purchase

Zoom out for a wide view before zooming in on the laser to choose.

By Scott LaBorwit, MD

Purchasing a femtosecond laser for cataract surgery is a major investment, so significant investigation and research is a must when deciding which platform to buy. Many surgeons make the mistake of focusing on the “cutting” of the laser — and, of course, its cost. While these are important factors, they are just two of many things to consider. Surgeons should evaluate all of a laser’s functionality and options, as well as the reputation and practices of the company that make it, before committing to a platform they’ll be working with for five to seven years.

As often happens in life, what at first seems most important can later be overshadowed by things that prove more critical in the long run. For instance, like many surgeons, when I first began comparing femtosecond laser platforms I was most interested in the laser’s lens-cutting ability. Two and a half years later, I have the lens cut turned way down so that it’s just enough to create the quadrants and cylinders I need to easily bowl out the lens to 4.7 mm. My overall phaco energy is still typically down 70% compared to traditional cases, and these days I am more focused on the imaging and computer algorithms than on the laser itself. So keep your investigation broad and thorough, knowing that your priorities may change over time. Here are some guidelines.

EQUATE IT TO A STOCK BUY

Purchasing a femtosecond laser requires a financial commitment approaching a million dollars over five years when you take into account the device, the patient interfaces and service contracts. With this in mind, I looked closely at the laser manufacturers as if I were considering buying stock. I wanted to invest in a company that would remain viable, with money to spend on research and ongoing product development.

I also wanted to work with a company that had the incentive and resources to engage with me, providing ongoing education and training, and whatever additional support I might need over the five-year period. Feeling good about the maker of your laser platform is an essential part of your decision.

WHAT ABOUT GLITCHES?

Yes, you will encounter a problem with your laser at some point. It may be a broken part, a sensor issue or even a computer glitch. I am confident in the knowledge and skill of my laser service representative, and it’s a comfort to see him in the laser room doing periodic, preventive maintenance to maintain the accuracy of treatments.

Of course, there was the day when the laser stopped working after the 14th of my 18 scheduled cases were done. After unsuccessfully troubleshooting the issue by phone, a service representative arrived at my office after driving nearly two hours from a neighboring state. He identified the problem, ordered the necessary part, then checked into a local hotel. The part arrived at his room by 10 p.m., and the next morning he was at my office at 6 to make the repair.

I didn’t expect this level of service — but as you can imagine, I was thrilled. The lesson is that you need to ask questions about technical support. Get specifics about regular preventive maintenance, as well as about how situations like these are handled.

KNOW THE COMPANY’S LEVEL OF COMMITMENT

Femtosecond laser technology is still in its infancy, and five or 10 years from now it will likely be very different compared to what it is today. My patients have had the benefit of four major technology upgrades over the last 30 months. The patient interface size got smaller, with less suction and a soft contact lens surface. Treatment time was reduced by 30% and energy was cut by 60%. New lens-cut patterns were introduced, and the capsular rhexus is now tag-free 97% of the time. Additionally, the laser can now use office diagnostics to center the rhexus and accurately line up astigmatism.

The manufacturer’s track record for keeping up with, or preferably being a leader in, evolving technologies is a critical factor to consider — as is the level of training and support that goes with them. Find out how accessible the maker is, whether it’s for a technology upgrade, an improved technique or laser training for doctors new to your practice, by contacting other surgical practices that have purchased the company’s laser.

THE MOVING TARGET ISSUE

With laser-assisted cataract surgery, keep in mind that what’s most important is a moving target. At first I thought the laser itself was the most important part of the equation. But while the equipment is essential, my operating room flow is equally critical in order to maximize volume efficiently, without compromising outcomes.

A year and a half after buying my first femto laser, I opened a second surgical center and bought another system. Fortunately, industry competition had grown, stimulating innovation and flexibility in pricing and contract terms. But those issues aside, my decision-making process was different this time. I asked more informed questions, valued different facets of the technology, and cared more about service and innovation than I had before. Your foray into laser-assisted cataract surgery is a journey that will evolve over time, like the technology itself. Make sure you take a wide view. Ask questions and think beyond the tools and techniques to be sure the platform you choose and the company you work with will serve your practice well for years to come. OM

Scott LaBorwit, MD, is a principal at Select Eye Care, with locations in Towson and Elkridge, Md., and is an assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com. Disclosures: Dr. LaBorwit is a consultant to and speaker for Alcon.