FEMTO FACTOR

Keep the laser running

A six-figure femto needs TLC — so buy it and plan it.

By Scott LaBorwit, MD

A laser unit used for cataract surgery is a complex piece of equipment, and sadly, there often is a direct correlation between that complexity and the likelihood of a glitch or breakdown. With its ocular coherence technology imaging systems, data-integrating software guiding the treatment and its many precise and sensitive mechanical components, myriad things could twitch on a femtosecond laser system. Given all this, let alone protection of your six-figure investment, it’s wise to follow the Boy Scout’s motto: Be prepared.

AN OUNCE OF PREVENTION

The first step is prevention. Take steps to protect your system from known environmental risks, such as extreme temperatures. Our laser room has a temperature sensor that is tied into the alarm system. It notifies me 24 hours a day if the room becomes too hot or too cold. I also have a battery backup on our heating and air conditioning units should the building’s power fail.

Next, make sure only properly trained staff touch the laser: these staff members alone power up and down the laser and run system checks. Ideal candidates are those who are competent and eager to learn new things and take on responsibility. While the laser manufacturer will provide initial training for your technicians, as surgeons you are ultimately responsible for everything that happens in your practice. So, it’s wise for you to be trained and to stay engaged by taking a periodic refresher course. This way you can be confident that your technicians are maintaining the integrity of the system and can handle any issues that might arise during a case. This also helps ensure proper training for new employees when there is turnover in your practice.

In my own surgical center, we limit the number of technicians who are allowed to turn the laser on and off, run system checks or make changes to the permanent treatment screens. This helps minimize potential problems due to mishandling of the equipment.

GET THE SERVICE CONTRACT

Last but not least regarding prevention, include a service contract in your femtosecond laser investment. These can be very expensive, but compared to the cost of replacing a laser — or the surgical fees you’ll miss out on if your laser is out of commission — the math is easy. Make sure the repair service contract includes a strong preventive maintenance component.

COMPARE NOTES

As you compare manufacturer options, call other doctors that perform laser-assisted cataract surgery. Ask about the frequency of preventive maintenance on their systems, the speed and responsiveness of the company’s technical support team in the event of an issue, and staff training programs. In my experience, a laser service engineer does preventive maintenance every few months to ensure the system operates as it should. If I ever have a concern, for example, if the corneal incisions are not opening as easily as expected, the engineer comes to observe cases and make whatever repairs or adjustments are necessary. An example I like to share is the time my laser stopped working in the middle of a packed schedule. The service engineer immediately made a two-hour drive to my office, diagnosed the problem and ordered a replacement part, then stayed in a local hotel to take delivery after the part was flown in that night. He was back before office hours the next morning to make the fix, and I was able to complete the rescheduled surgeries from the day before that morning.

IF THE SYSTEM GOES DOWN

After two-and-a-half years and more than 2,000 cases, I’ve never experienced a situation in which the laser stopped working during a treatment. However, on a few occasions I have gotten an error message immediately prior to a treatment, with a patient in the room and under the stretcher. This is awkward, but usually you can resolve the error by restarting the system, much like rebooting your personal computer.

I’ve experienced only two instances when I had to cancel procedures because I couldn’t get the laser back up and running. At those times I have found a straightforward, personal approach works well when explaining such inconveniences to patients. If they are already in the office, I meet them in an exam room to explain that the computer that operates the laser has locked up, and that a service engineer is on the way. I explain that we will call them to reschedule their procedure as soon as we know when the laser will be back online. Most patients can relate to a computer not working. I have never offered a traditional cataract surgery: should a complication develop or a less than optimal outcome ensue, the patient would likely regret not waiting for the laser to be repaired.

Technical difficulties are an inevitable part of innovations like laser-assisted cataract surgery. Having plans to prevent potential problems and to deal with those you can’t anticipate are critical for any laser-assisted cataract surgeon. 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.