The debate is heating up.  Voices are getting louder.  Is the femtosecond laser just a $500K answer to the capsulorrhexis’ bent-needle-cystotome (that most of us out of residency don’t really need help with anymore), or is it truly a game-changing technology for cataract and refractive eye surgeons?  I have myself, until recently, been arguing that this is just a very expensive toy with no real way to ever cover the costs of acquisition.  I’m beginning to change my view…

It seems every month, now, a new use of the Femtosecond laser is discovered.  Dr. Josef F. Bille, Ph.D. has presented a method of using the Femtosecond laser to adjust the power of an IOL after it has been implanted in the eye.  Unlike the light adjustable lens by Calhoun Vision, the Femtosecond laser technique could be used on standard acrylic hydrophobic IOLs (such as the Alcon Acrysof).  In theory, this technology could replace LASIK as a method of fine-tuning residual refractive errors in almost any pseudophakic patient.  Suddenly, we have a real benefit with a proven revenue generation pathway.

The potential doesn’t end there, however.  As the technology improves, one could envision the ability to create patterns within the IOL that could result in multifocality.  If this proves to be possible, even patients who chose not to have (or had cataract surgery prior to the availability of) a multifocal IOL could choose to “upgrade” at a later date.

The technology, called Refractive Index Shaping (RIS) requires more than just a $500K Femtosecond laser.  For it to work, the laser must be coupled with a 2-photon microscope – or differential interference contrast (DIC) microscopy – and a Heidelberg Retina Angiograph II (HRA 2).  I don’t know what a 2-photon or DIC microscope is, but it sounds expensive.  In other words, it does not appear that any of us will be able to purchase the Femtosecond laser and use it as a type of ophthalmic surgical Swiss Army knife.  Rather, it appears that it will be more like modern video game consoles that come with one or two lame games (such as creating a perfect capsulorrhexis), but for the real fun you will have to spend the extra $$$ on the real stuff.

For those of us in solo practice (like me), this may be a game that we simply cannot afford to play no matter how cool it may be.  More to come, no doubt…

David Richardson, M.D. ^[1]
California Cataract and Canaloplasty Surgeon ^[2]
San Gabriel Valley, CA