Viewpoint

A brilliant idea, dulled by myopia

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

Recently we’ve seen some remarkable advances in ophthalmic surgery, such as microshunts for glaucoma and femtosecond laser technology for cataract surgery, as well as intraoperative aberrometry. On the pharma side, anti-VEGF solutions for retinal diseases are helping to stave off blindness.

Another recent innovation is the concept of integrated solutions. With cataract surgery a surgeon can take measurements with one device in the office, then load those measurements directly onto the femtosecond laser, operating microscope or both. Laser arcuate incisions can then be placed precisely at the correct axis. The surgeon positioning a toric IOL sees the exact position the implant needs to be rotated via a microscope, heads-up display. No more inaccurate ink marks. This concept was introduced by one company and at least one other is chasing its lead, with more likely to follow.

I think this is brilliant, as it has the potential to dramatically reduce errors on so many levels. But its brilliance is likely dulled by one fact. Because the systems are by definition “integrated,” it’s likely that they will be integrated only within one manufacturer’s system and not interactive with another company’s products. In other words, will the measuring device only talk to one brand of laser, or one type of microscope?

For some of you this is no problem. You use Brand X for everything, and you can’t imagine looking at another company’s products. That’s your call. I’m different. I use a phaco machine made by Brand A, a femtosecond laser from Brand B, premium lenses mostly from Brand C but some B, standard implants from Brands A and C, viscoelastics from Brands A and D, a microscope from Brand E, and so on. And that’s all fluid — it will likely change over the next few years. I have a hard time believing any one company every year has the best of everything, so I pick and choose what I think is best in each category. (My company reps would disagree, stating quite confidently that all their products are indeed the best, until they move to a different company, at which time they assure me their prior employer had misinformed them.)

So while the idea of integrated products is a game changer, I am asking those upon whom our professional lives are dependent to please consider cross-integrating the integration. Make some sort of hardware/software adapter (even at an extra charge to us) so your product will work with other devices. As surgeons and ASC owners, our reimbursement is not increasing; we can’t continue to divert all these extra expenses onto the backs of patients, who often don’t want or can’t afford “premium” surgery. Right now I need some new equipment but I’m afraid to buy anything for fear my new devices won’t integrate with something else I need down the road.

PC and Mac figured out interoperability. I’m sure we can as well. OM