FEMTOSECOND LASER CATARACT SURGERY AN EXPENSIVE GIMMICK SÜLEYMAN KAYNAK M.D FEBO UNIVERSITY OF DOKUZ EYLÜL İZMİR.
FINANCIAL DISCLOSURE NO
IS CATARACT A COMMON PROBLEM? According to the World Health Organization (WHO), cataract ise still the most common reason for visual impairment. This figure accounts for half of the total number of visually impaired persons: 48,7% (1).
IS CATARACT A COMMON PROBLEM? There are slightly more than 348 million people over the age of 70 and the cataract rate over 70 is accepted as 40%. According to this, there are 140 million cataract patients just in the age span over 70(2).
IS CATARACT A COMMON PROBLEM? In the last three decades, cataract surgery transformed from intracapsular surgery to extracapsular surgery and then to phaco surgery. Today, phaco surgery is a widespread method around the world. It is estimated that approximately 25 million cataract surgeries are performed every year. Phaco surgery has successfully become an ordinary and routine surgery method and every cataract surgeon has invested in it and continues to do so.
IS PHACO SURGERY COMMON NOW? Phaco surgery is the golden standart now all over the world included the developing countries. As phaco surgery became more common, disposable and cheap materials started to be used for this surgery. The steps of the surgery are as follows:
IS PHACO SURGERY COMMON NOW? 1. Phaco incision: mostly made with a 2.8 blade. 5-10 2. Side stab incision: made with a 1.1 blade. 4-8 3. Capsulorhexis: made by cystotom or a reusable forceps. 2 / 200
IS PHACO SURGERY COMMON NOW? 4. Hydrodissection: made by HD needle : 2 5. Chopping nucleus by chopper and phaco tip 6. Aspirating nucleus particles: Phacoemulsification 7. Irrigation aspiration: Reusable tips. 8. OVD : 15-20
IS PHACO SURGERY COMMON NOW? 9. IOL implantation 10. OVD removal 11. Swelling wounded areas and introducing antibiotics into the anterior chamber
TOTAL COST OF PHACO SURGERY : Total Cost per package in Turkey : 210 USD Total Cost per case in USA by Medicare : 1061.14 USD ( 212.23 : USD Copayment by patient)
FEMTOSEC CATARACT SURGERY : In FS laser cataract surgery, the 1.-2.-3. and 5th phases stated herein are performed and then phacoemulsification and sequential steps are performed again with phaco surgery.
FEMTOSEC CATARACT SURGERY : In the near future, there will be studies and technological developments in order to perform these phases with laser applications as well. However, it might be said that there is an disproportional relationship between the cost per surgery and the performed surgery.
FEMTOSEC CATARACT SURGERY : - The issues regarding FS laser to be discussed today are as follows : Is it an efficient technology? What is the gain of this surgery? What is the patient s gain from this application? What are the technical superiorities over today s phaco technology? What is the price-performance relationship?
FEMTOSEC CATARACT SURGERY : Let s try to answer these questions: IS IT AN EFFICIENT TECHNOLOGY? - What we know from literature: Better cornea incision Better capsulorhexis Astigmatism control More reliable and repeatable results.
FS CATARACT SURGERY : IS IT AN EFFICIENT TECHNOLOGY? - What we don t know from literature: Less endophtalmitis Less posterior capsule and vitreous loss Lens position is more predictable Less endothelial cell loss with less ultrasound.
FS CATARACT SURGERY WHAT IS THE PATİENT S GAİN FROM THİS APPLICATION? - What literature is not capable now but may perform in the future: Lack of randomized clinical studies Lack of standard way of application Lack of clear understanding of patient s gain Difficulties in price analysis.
FS CATARACT SURGERY : WHAT ARE THE TECHNİCAL SUPERİORİTİES OVER TODAY S PHACO TECHNOLOGY? LET S COMPARE THE FACTS: Better cornea incision: Rate of complications due to cornea incision in phaco? Leakage Astigmatism- Iris prolapsus- Wound seperation Corneal oedema. Better capsulorhexis: Complication rate? Capsulorhexis may not be assymetric ruptured standard? Tilt decentralisation Better astigmatism control: Incisions are narrower and short: It doesn t make much difference. Less phaco power and endothelium protection: Phaco power is already lowered considerably and endothelial cell loss in soft cataracts is decreased to 3%.
FS CATARACT SURGERY: WHAT İS THE PRİCE- PERFORMANCE RELATİONSHİP? EVALUATION: IF A COST ANALYSIS TO BE MADE FOR; A little bit better corneal incision A little bit more round capsulorhexis A little bit more predictable astigmatism A little bit less phaco power and endothelial cell loss
FS CATARACT SURGERY : COST? If we perform 25 cases per month : No payment by insurance companies?? Investment Maintenance Training expenses Operating rooms ( two rooms) Additional staff and time. Mostly addional expenses per case : 1000
FS CATARACT SURGERY: WHAT İS THE PRİCE- PERFORMANCE RELATİONSHİP? CONCLUSION AND COMMENT: It is early for us to evaluate FS Laser Phaco surgery technically. The distinction of the following should be made carefully for this application: Patient gain Surgeon gain Industry gain
FS CATARACT SURGERY The final decisions have not been made on its effectiveness and safety with respect to cataract surgery. It is a technology under development.
FS CATARACT SURGERY As it is the case for evey developing technology, the prices are still very high. With regards to patient, surgeon and industry gain, we can say that there isn t yet a balance for the patient gain in medical sense.
FS CATARACT SURGERY For paying agents; Cost analysis reveals that it doesn t seem to be affordable in the near future. For acquired health results; The cost seems too high when compared to the minimal benefits and quality increase to be obtained.
FS CATARACT SURGERY It is not right to stand in the way of science, however: When there are around 250 million cataract patients including 140 million patient over the age of 70 around the world and the rate of these patients to access doctor care is around 5% in Africa and southeastern Asia, it does not seem to be the appropriate choice to add an additional cost of a 1.000 to cataract surgery.
THANK YOU FOR KIND ATTENTION.