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The Poughkeepsie Journal

Modern cataract surgery is as good as laser, cheaper

11:40 PM, Jul 16, 2012   |  Written by Eric R. Brocks

In the interest of patient education and safety, a recent article in the Poughkeepsie Journal about cataract surgery requires clarification, (“Laser streamlines cataract surgery,” June 17).

Having served as a faculty member of New York University Medical Center for over 30 years, I can state that cataract surgery today is one of the most successful surgical procedures performed in all of medicine. This fact, however, has nothing to do with the use of a laser.

Like any other surgical procedure, cataract surgery involves some risk, so it should only be performed when it is necessary. That threshold is only reached, in nearly every case, when a patient feels that his or her vision is no longer adequate to have a comfortable, functional lifestyle, and when no other condition is mainly responsible for the visual loss.

If a patient comments, as in the article, “my vision wasn’t affected, but... it seemed like a painless, short procedure, and I wasn’t worried,” one might wonder why she would be “told by her ophthalmologist she had cataracts... that needed to be removed with the newest laser procedure.”

If there is a visual reason for performing cataract surgery, and this outweighs the risk of performing surgery, then it should be made clear that there is no reason the surgery “needs” to be performed with a laser.

There is no convincing data at this time that show any advantage to performing cataract surgery using a laser over the time-tested and proven microsurgical techniques used by most ophthalmologists today. No difference in safety, no difference in visual results, no difference in recovery time.

Although I would agree that “cataract surgery has undergone an incredible amount of evolution in 60 years,” the use of lasers in cataract surgery is still a developing technology, and has not yet earned its place as one of these great advances. The technique of phacoemulsification, used by most surgeons, has earned that place. Indeed, following laser pre-treatment, phacoemulsification is still used to remove the cataract when performing “laser cataract surgery.”

From the patient’s standpoint, there is no difference in the experience using either technique. Either way the patient can generally have same-day ambulatory surgery, be up and about the day of surgery, “bend immediately, drive the next day,” et cetera.
I would also agree that, as the article says, “the con is money.” Traditional, state-of-the-art microsurgical cataract surgery with intraocular lens implantation is covered by insurance, while the additional “$1,200 per eye” for using the femtosecond laser is not.

In fact, Medicare forbids billing patients or their secondary insurer for any additional fees to perform covered components of cataract surgery with a laser. The question is, will the extra $2,400 give me a better visual result? The answer is, I can’t prove that it will.

In short, the patient and physician should discuss all of the options available, including when and why cataract surgery is needed, the type of lens implants that are available, the proven advantages of each type of surgical technology, and what are reasonable expectations after surgery, before a patient decides when to proceed, and which course to take.

My advice for patients? Don’t be afraid to ask questions!

 

 

Eric R. Brocks is the director of the Department of Ophthalmology at Vassar Brothers Medical Center.

 

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