Up Front | Sep 2013

Chief Medical Editor’s Page

New Technologies and the Anxieties They Generate

When discussing new technologies in 2013, the first thing that springs to the minds of most anterior segment ophthalmologists is laser-assisted cataract surgery. I know this topic raises anxiety levels among some colleagues—and there is no doubt that this technology is causing considerable disruption in our practice of cataract surgery. It is expensive, and the question, “Is it worthwhile?” is still being answered.

I vividly recall the early days of IntraLase (now Abbott Medical Optics Inc.) and the vocal opposition to the technology by critics—some well-known, including one of my mentors. I made the choice to acquire the first femtosecond laser in the United Kingdom, not for a marketing advantage but as a safer option for my patients. As we realized soon after its acquisition, LASIK flap creation with a femtosecond laser was not only safer but also provided significantly better outcomes. Yes, the marketing advantage helped, although it boosted our bookings by only 5%; but, with this higher volume combined with the increased price for LASIK, our revenue increased by 30%, and the laser was paid off a year earlier than planned. Interestingly, a choice made to provide patients with better care wound up making us more profitable. This has occurred many times in the past: Consider the introductions of the IOL, extracapsular cataract surgery, phacoemulsification, and Healon (Abbott Medical Optics Inc.)—the list is endless.

This month’s focus on new technologies includes a collection of articles covering issues that are on all of our minds: Should we acquire a given technology? Is it essential? When would be a good time? If we wait too long, will we lose out? Can we afford it? Will there be better deals in the future? There are no clear answers. Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin), puts these issues together quite cleverly and succinctly. The main point he makes is this: Much depends on the individual and whether he or she is an innovator, early adopter, or laggard.

Unlike the scenario of femtosecond LASIK, in which IntraLase had the only product on the market for many years, already there are multiple players in the arena of laser-assisted cataract surgery. The question is, which provider does one choose? No one wants to invest in technology that might become an orphan. Marguerite B. McDonald, MD, raises interesting issues about the failure of products and cites, among many factors, the role of corporate management. For the members of industry reading this, pay attention: There is considerable considerable validity in her arguments. Another issue that I would like to add to hers is this: How long can a company with a catalog of one product survive, even with good corporate management? Some technologies are expensive and, to ensure good return on investment, buyers must also consider technological advantages, local relationships and service, and the overall transaction. Because new technologies are bound to change, the technological pipeline and time to implement are further points to consider. Both are worth including in any purchase contract.

One comment is often made to me as an early adopter of laser-assisted cataract surgery: “Femtosecond lasers are not essential for cataract surgery, so why take the financial risk?” There are fine cataract surgeons who can do fairly reproducible surgery and obtain good outcomes, so this is a point well taken. However, early investigative work has demonstrated statistically significant advantages with this technology, as outlined in the article by H. Burkhard Dick, MD, PhD, and Tim Schultz, MD. Eventually, randomized controlled studies will provide definitive answers. For those of the analytic mindset, perhaps they should wait for more outcome studies before taking the plunge.

We each have our own drivers. For me, as a prosumer of technology and as an opinionated individual, I like to influence change. I enjoy working closely with our industry partners and helping them make decisions about how their technology can be improved, what directions they should consider, and where boundaries can be challenged. Seeing the fruition of these contributions is satisfying.

My principal driver, however, is to provide patients with what I believe is the best possible care. Centre for Sight has positioned itself as a high-end practice, and patients come to us in trust to obtain top-quality care. In my experience, they are not over-concerned with the technological details of how I get them to the endpoint they are looking for, but they want to be reassured that I will provide them with a good outcome using the best technology available and, in the process, have a first-class patient experience. I am in agreement with Steven B. Siepser, MD, “Technology assists us in our quest for faster, better outcomes.” We all want our patients to get the best possible outcomes the first time around, and technology certainly helps us achieve this goal.