Panorama Eye Care, specifically our Northern Colorado practice, was an early adopter of femtosecond-assisted technology in our premium cataract surgery offerings. We received our first unit in 2011, the 12th unit delivered in the United States. Although we had great successes, and despite regular software updates from the parent company, our single unit began to show its age.

After hearing several persuasive discussions from prominent ophthalmologists in major meetings regarding advancements in femtosecond laser–assisted cataract surgery (FLACS), the decision was made to explore our options. We had several fundamental changes in our practice that influenced how we should go about instituting a major change:

• First, in 2021, our practice sold to a private equity partner, and we quickly upgraded from one 3-room ambulatory surgery center (ASC) to 5 separate ASC entities.

• Second, we had a long-standing relationship with a single surgical company that provided not only support for our laser but also the cataract units, surgical packs, and support equipment that was used in surgery all day, every day.

• Third, we already felt we had maximized cost-effectiveness with our current technology and partnership. A question relating to this point arose: Would a change in technology impact all that we had worked hard to create evaporate?

• Fourth, we had many new cataract surgeons, each with differing opinions within our core group of surgeons. We began to question whether a buy-in with new platform-wide technology would be possible.

• Fifth, we felt that our present conversion rate was adequate, but would the change in technology meaningfully increase our premium conversions as touted by the experts, or would we stay the same or lower with the change?

Because we were not looking for just 1 new femtosecond laser for our primary office, but 6 new units for the platform, it was necessary to explore options. We took a deep dive into all the available technologies and decided that we would consider 3 possibilities: a brand-new take on our existing technology and a partnered company, and 2 other technologies that have been increasing market share in the premium cataract surgical space.

We did our own research into web-based information available on each unit. We set up meetings with our area reps and the district managers from each individual company, in addition to networking in depth with each company’s C-suite executives at major meetings. We invested time in wet labs geared toward hands-on experience with each individual technology. We also considered several head-to-head studies in respected cataract-focused journals.

We came up with an extensive list of pros and cons related to each specific technology. This exhaustive, but not exclusive, list included topics such as:

• Mobility of each laser within our laser rooms

• Speed and accuracy of treatments

• Compatibility with existing cataract planning technology

• Whether or not the technology was cloud-based

• The existence of cloud-based artificial intelligence learning for improved outcomes

• Capsulorrhexis abilities of treating optical centers vs pupil centers

• Expense of technology

• Ease or difficulty for staff to operate the laser technology and the critical buy-in of the technology by staff in the ASC

• Levels of marketing assistance by the parent company

• Quality of corneal incisions

• Laser transmission bubble size in capsulorrhexsis creation

• Blind passes vs true visualization of every laser incision

• Ongoing accessibility of engineering for technical issues with potential problems

• Accessibility of company expert advisors on integration and training

• Potential upgradability for future improvements

Next on the list for research, we spoke with a variety of relevant parties. These groups included friends and colleagues who are highly respected surgeons in terms of teaching and vast experience, each cataract surgeon who belongs to our organization, surgeons who have experienced or will experience the platforms under consideration, and company C-level executives, who provided a surprising amount of off-the-record candid information that was extremely helpful.

Finally, the time came for in-office demonstrations, allowing surgeons with a vested interest a chance to try the technologies in real-world ASCs with actual patients. This was the final trial that would give the best assessment of whether the hoped-for technology could surpass the tried-and-true technology that we surgeons and staff have become accustomed to and relied on over many years. Throughout this process, our CEO put forth his best bargaining effort to create the greatest deal over the number of units purchased, costs per procedure, and return on investment for the ASCs.

Our process took approximately 8 months to complete, and the end vote was not unanimous. We voted to go with technology that was different than the one we had been using for 15 years. However, one of our physician groups adamantly refused to change and kept their long-standing laser unit. The remainder of our groups incorporated this new technology into their ASCs.

Six months into our decision, the doctors are overwhelmingly happy with the choice, and our staff operators have followed suit with enthusiasm. Changes in conversion rates are as follows: For the overall platform, we moved from a 28% premium conversion rate in the first half of 2025 to a 38% conversion rate in the first half of 2026. Our small satellite office in a smaller market moved from 4% and 2% in the first and second halves of 2025 respectively to 25% in 2026. Time will tell if these changes are sustainable, but this excellent start, no doubt, is due to the combined efforts of better technology, the diligent process for choosing a new femtosecond laser, and subsequent internal enthusiasm—plus buy-in by the doctors for a step forward in our ability to meet patient expectations.

For our group, undertaking a major decision to change technology for such a premium product in an ASC was an exercise that can and will be followed for any other major potential change in how care is delivered in our practice. At its core, we adhered to the established and trusted tenets of evaluating whether the new technology was comparable or superior to what we were currently using, whether it saves money for the patient and/or the company, and whether shorter procedure times would allow more cases to be performed in the same timeframe. Half a year into this, we are going strong and have not looked back nor regretted our decision.

Karl Olsen, MD, is a cataract surgery and laser vision correction specialist at Panorama Eye Care’s Eye Center of Northern Colorado, where he is also a physician advisory board member. Reach him at kolsen@panoramaeyecare.com.