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Laser-Assisted Cataract Surgery, Is It Worth the Risk?

Laser-Assisted Cataract Surgery Risks

Is Laser-Assisted Cataract Surgery Worth the Risk?

A commonly accepted rule-of-thumb among surgeons is that additional risk must be balanced by additional benefit to the patient. But, what benefit does the patient get for the potentially high price of added risk? Seemingly nothing other than a lot of hyperbole, vacuous promises of “greater precision”, and disingenuous suggestions that Femto Laser-Assisted Cataract Surgery is necessary in order to get the full benefit of “premium” IOLs.

Because of this combination of added risk without clear benefit to the patient, more than a few eye surgeons (myself included) now believe that charging patients for laser-assisted cataract surgery is not only unjustified, but potentially unethical. Medicine needs new technologies, and the benefit may not always be apparent early on in the adoption phase. That’s generally accepted in medical circles. Forcing patients to pay substantial amounts of money for unproven technology, on the other hand…

What, Exactly, Are You Paying for When You Opt for Laser-Assisted Cataract Surgery?

Laser-assisted cataract surgery costs hundreds to thousands of dollars more than cataract surgery done without a laser. Given the lack of proven benefit, what are your really getting for this extra fee?

First, why don’t we look at what Medicare (the largest payer of cataract surgery) says about this (you don’t really have to read this as it’s boring and I’m going to summarize it below). I’ve added emphasis to the key parts:

Medicare Part B covers the cataract surgery and the implantation of a conventional lens without regard to the technology used. Revised November 2012 Femtosecond Laser Guidance Imaging performed as part of the FS laser surgery, which is necessary to implant premium refractive IOLs, is considered a non-covered service as long as these services are not used routinely when implanting conventional IOLs. A separate charge for the imaging is allowed with that consideration. However, as set forth above, Medicare Part B covers the cataract surgery without regard to the technology used. The Medicare beneficiary receiving a premium refractive IOL may be charged for non-covered services (such as imaging), but not for using the FS laser to perform covered steps of cataract surgery, such as the phaco incision, capsulotomy, and lens fragmentation.

What?!

Translation: If you are a Medicare beneficiary you cannot legally be charged an extra fee for laser cataract surgery unless you have astigmatism or are opting for a “premium” or “refractive” intraocular lens (IOL) such as a multifocal IOL or “pseudoaccommodating” IOL (such as the Crystalens). You see, the Femto laser falls under Medicare’s “Golden Scapel” rule. It doesn’t matter whether a surgeon uses a metal, diamond, gold, or laser to perform surgery – unless something other than standard cataract surgery is done the surgeon or surgery center cannot charge Medicare patients an additional fee.

Correction of astigmatism or placement of “premium IOLs”, however, is considered refractive surgery. So long as refractive surgery is also being performed during cataract surgery then Medicare allows an extra fee to be charged to the patient.

“But,” you ask, “is the laser required for placement of a “premium” IOL or correction of astigmatism?”

The answer may surprise you:

“No.”

Why Pay More for Laser-Assisted Cataract Surgery?!

So, why would anyone choose to pay more and undergo additional risk just to have their cataract surgery assisted by a laser? There must be scientific studies to prove that it is a safer and more reliable method of removing a cataract, right?

Wrong! (see Is Laser-Assisted Cataract Surgery Better than Surgery Done without a Laser?)

Sadly, it’s the same reason people choose to pay more for one consumer brand over another…

…marketing.

Millions of dollars have been spent by the manufacturers of Femto lasers to convince both doctors and their patients that laser-assisted cataract surgery is superior to cataract surgery performed without a laser. The industry has tried everything from intimate dinners at expensive restaurants to rock concert like presentations with laser light shows and loud music (I’m not kidding) to sway the views of eye doctors. Many have been impressed enough by these presentations to spend up to a half million dollars to purchase one of these Femto laser units. Yes, that’s up to $500,000 just to purchase the laser. On top of that the laser companies charge another $300-800 each time the laser is used on a patient.

Think someone who just spent a half million dollars might be just a little incentivized to recommend laser cataract surgery to his or her patients?

“Just saying…”

But let’s say you’ve got a few thousand extra dollars burning a hole in your pocket. Should you go ahead and have laser-assisted cataract surgery just for braggin’ rights? I suppose you could. After all, spending hundreds to thousands of dollars to have Femto laser-assisted cataract surgery (which takes longer to perform than cataract surgery without laser use and has no convincing evidence that the final vision will be any better) is a bold statement that “I have money to burn”.

Or, perhaps you’re a base-jumper and just like to take unnecessary risks?

But for my money and knowing my patients (who generally think taking unnecessary risk or throwing money away should be avoided, not bragged about), I think there’s more benefit and bragging rights to be had by spending those funds on a vibrant new 70” 4K flat screen TV like this one:

With your post-cataract surgery crystal-clear vision (which may be more likely without the use of the laser) you will now be able to enjoy the subtle beauty of this high-definition display as well as have something substantial to brag about.

70” 4K flat screen TV

Popcorn anyone?

By the way, you can make popcorn with a laser too.  “But,” you say, “that would take longer than using the microwave and I don’t think the popcorn would taste any better – so why would I want to use a laser to make popcorn?”

Sound familiar?  Why indeed?

Dr. David Richardson has performed thousands of cataract surgeries without the need for laser assistance. Although he finds Femto technology to be interesting he is far from convinced that there is any real benefit to his patients. As such, he has chosen not to recommend this technology to his patients who need cataract surgery.

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