Surgeons and centers share their thoughts on introducing laser cataract surgery into practice.
By Boon Siong Lim; R.J. Mackool, MD; Richard J. Mackool, MD; Erik L. Mertens, MD, FEBOphth; and Julian D. Stevens, MRCP, FRCS, FRCOphth
BOON SIONG LIM
Before introducing laser cataract surgery at Vista Eye Specialist last October, a task force was established in consultation
with our surgeons to develop a strategy to incorporate the new technology into practice. Our experience as the first practice in Malaysia to offer bladeless LASIK with the IntraLase femtosecond laser (now Abbott Medical Optics Inc.) in 2003 was invaluable in this process, as it represented the first time we had to work to overcome patient concerns and misconceptions. Below we recount our efforts to introduce and market laser cataract surgery to our patients.
We were also the first in our region to perform laser cataract surgery, and with that came pressure to identify a unique brand name that would garner attention as well as present the main concept of the product. After a brainstorming session, we decided on the name no-blade cataract surgery as a follow-up to our no-blade LASIK brand name, which was instrumental in the successful launch of IntraLase in our region. The no-blade
term, aimed at reducing the fear associated with bladed surgical techniques, was simple to understand and clearly defined the difference from a conventional phacoemulsification technique.
By likening the LenSx Laser System (Alcon Laboratories, Inc.) to the IntraLase technology—an accepted technology in the LASIK market—in our campaign, we took the fear away from patients of using a new, unproven technology to perform a crucial surgery. With the wide use of femtosecond LASIK and its proven results and safety, the link between using femtosecond lasers for refractive surgery and cataract surgery reduced the time
we needed to educate patients about the technology. It also quelled patients’ initial fears and raised the acceptance level of laser cataract surgery. Our slogan, “No-Blade LASIK since 2003, Now No-Blade Cataract Surgery,” was chosen to reflect this.
Whenever something new is introduced, comparisons with older techniques are bound to occur. Because traditional blade cataract surgery and phacoemulsification is widely performed and the results are acceptable, general resistance to something new, especially one that comes with a premium price, can be expected. Another concern is overcoming the myth and misunderstanding that phacoemulsification is already laser cataract surgery.
We find it helpful to illustrate to patients how cataract surgery has evolved, clearly defining the techniques and technologies used over the years and how they have made a difference in patient care and comfort, surgical quality, and safety. Emphasizing how laser cataract surgery is different from what the general population accepts as a laser (ie, phaco) is important. Using a chronological timeline, we depict the evolution
of cataract surgery, from couching to intracapsular cataract extraction to extracapsular cataract extraction to phaco, and finally the evolution toward laser cataract surgery in 2009.
Our efforts to introduce laser cataract technology into practice were successful in overcoming patient fears. By making a parallel of the unknown (ie, laser cataract surgery) with something already common (ie, femtosecond LASIK) and by clearly defining the difference with what is being offered (ie, the difference between laser cataract surgery and conventional surgery with phacoemulsification), we booked 200 cases before
officially launching the procedure and completed 125 cases in the first 2 weeks of certification. Nine months later, our conversion rate is 42% of all cataract cases, of which 68% include premium lens implantation.
Boon Siong Lim is the CEO of Vista Eye Specialist in Malaysia. He states that he has no financial interest in the products or companies
mentioned. He may be reached at tel: +60 12 283 7927; e-mail: boonsiong@vista.com.my.
R.J. MACKOOL, MD; AND RICHARD J. MACKOOL, MD
We have not done external marketing of laser cataract surgery at the Mackool Eye Institute and Laser Center. Prior to each consultation, we provide patients with written material that describes our positive experience with femtosecond laser technology, including the precision and benefits of the method and its ability to simultaneously correct astigmatism, create surgical incisions, and facilitate cataract removal. We
also include an overview of IOL options and opportunities for reduced spectacle dependence.
We have found that our ability to offer patients the most advanced technology, including laser cataract surgery, is very reassuring to them. Their knowledge that we perform procedures that are on the cutting edge increases their confidence in our recommendations.
R. J. Mackool, MD, is the Assistant Director of the Mackool Eye Institute and Laser Center in Astoria, New York. Dr. Mackool states that he has a royalty agreement with Crestpoint Management. He may be reached at tel: +1 718 728 3400, ext. 256; e-mail: mackooleye@aol.com.
Richard J. Mackool, MD, is the Director of the Mackool Eye Institute and Laser Center in Astoria, New York. Dr. Mackool states that he is a consultant to Alcon Laboratories, Inc. and has a royalty agreement with Crestpoint Management. He may be reached at tel: +1 718 728 3400, ext. 256; e-mail: mackooleye@aol.com.
ERIK L. MERTENS, MD, FEBOphth
Marketing laser cataract surgery in Belgium can legally be done through the practice’s website and informational brochures
as well as by word of mouth or by educating one’s own cataract patients. Before marketing strategies are put in place, however, one must focus on creating awareness.
Creating awareness among patients that cataract surgery can be done with a femtosecond laser begins with thorough explanation
of the procedure’s advantages. At Medipolis, we achieve this with written and oral information. Our professionally trained patient counselors explain the potential benefits of this new technology. Thus, we educate our patients that this new laser device lifts cataract surgery to a higher level. It is important to explain that conventional cataract surgery with phacoemulsification is still a good procedure, but we can do even better now using a laser to facilitate integral steps of the procedure.
Our counselors stress to patients the softness of the procedure which tool will give a more precise outcome, a scalpel or a laser?—and describe how the laser is more gentle on the inner tissues of the eye, producing less endothelial cell damage. Additionally, they communicate to patients that using laser cataract surgery encourages greater accuracy in lens surgery because the incisions and manipulations inside the eye are no longer
created by hand, and that corneal astigmatism can be corrected simultaneously, without touching the cornea with a knife.
I am amazed to see how many patients are already embracing this new technology and benefitting from their newly improved eyesight in all circumstances after laser cataract surgery.
Erik L. Mertens, MD, FEBOphth, is Medical Director of Medipolis, Antwerp, Belgium. Dr. Mertens is a Chief Medical Editor of CRST Europe. He states that he is a consultant to Bausch + Lomb, Topcon, Technolas Perfect Vision GmbH, and STAAR Surgical. Dr. Mertens may be reached at tel:
+32 3 828 29 49; e-mail: e.mertens@medipolis.be.
JULIAN D. STEVENS, MRCP, FRCS, FRCOphth
At Moorfields Eye Hospital, the majority of our patients seek refractive correction rather than purely the treatment of cataract. As demand for the benefits of laser cataract surgery already exists, we feel it unnecessary to attract a new type of patient via external marketing. Rather, our strategy is to focus on educating patients who have already been drawn to the practice because of our reputation as a high-end provider of both refractive and cataract surgery. We provide information to patients that highlights the benefits of this new procedure and explains the key
differences between laser cataract surgery and what we refer to as traditional, entirely manual phacoemulsification. The benefits are reiterated at all stages of the patient’s journey, and not just by the surgeon. We feel it is vital to have members of the team who can confidently communicate with the patient about the new procedure.
As recommendation is our biggest referral source, we continually gather patient feedback. We will also be watching closely to see how many future patients come to the practice asking for laser cataract surgery based on word-ofmouth referral.
Julian D. Stevens, MRCP, FRCS, FRCOphth, is a Consultant Ophthalmic Surgeon at Moorfields Eye Hospital in London. Dr. Stevens is a member of the CRST Europe Editorial Board. He states that he is a consultant to Abbott Medical Optics Inc., Revision Optics, Oculentis, Topcon, and OptiMedica. He may be reached at tel: +44 20 7253 3411.
