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Cover Focus | Sep 2015

Can You Get Your Money’s Worth From Surgical Planning Devices?

One surgeon presented a cost analysis at a recent AECOS meeting.

In the past few years, the number of devices available for cataract surgery planning and implementation has surged. From image-guided cataract surgery platforms and intraoperative aberrometry devices to systems that automate toric IOL alignment, these technologies all have a similar goal: to provide the surgical navigation and guidance required for refractive cataract surgery.

If you need a refresher on the plethora of devices that can aid in surgical guidance, the September 2014 issue of CRST Europe covered this topic in great detail, overviewing each available system and providing pointers for its use (http://crstodayeurope.com/2014/09/). In short, these systems help surgeons to eliminate a multitude of errors that can occur during cataract surgery, increase the efficiency of the procedure, and deliver more accurate refractive results—all of which translate to improved patient outcomes.

two camps of surgeons

With regard to use of these devices, there are two camps of surgeons. Those who have acquired one or more of these latest technologies argue that, with these tools in hand, they can more easily deliver excellent unaided visual quality to the majority of their patients. On the other hand, those who have not yet purchased this type of equipment tend to feel that the financial burden may be too large.

Which camp is right?

cost analysis

Recently, at the American-European Congress of Ophthalmic Surgery (AECOS) 2015 European Symposium in Berlin, William W. Culbertson, MD, shared his cost analysis for one of the integrated surgical platforms available today. According to his figures, one can not only recoup the combined cost of the Lumera 700, IOLMaster 500, and Callisto Eye (all by Carl Zeiss Meditec) but can also turn a profit.

“Say I used [these systems in] a modest few thousand cases over a 5-year period. It would cost [my center approximately] US$60 per case for all these things,” Dr. Culbertson said. More realistically, taking into account that the Callisto is used only for patients who receive a toric IOL, the total cost per case in his center rises to approximately US$130, he explained, assuming that a toric lens is required in 10% of patients. Looking at it another way, Dr. Culbertson added his center’s out-of-pocket cost of the surgeon fee for toric IOL implantation (US$1,000), multiplied this by the number of toric patients, and subtracted the capital cost of the Callisto Eye, to come up with a total profit of slightly more than US$250,000. Although costs and pricing vary between practices, the bottom line is that profitability using this or similar systems is possible.

“There are all different types of scenarios in different countries and different clinics,” Dr. Culbertson said. “[But] in general, I think these integrated suites can give you a better bottom line, better outcomes for the patient, [and] greater efficiency in the OR.”

One challenge, he admitted, is that practices cannot use integrated cataract surgery software as a marketing tool the way they can with laser-assisted cataract surgery and other advanced technologies. This is because patient awareness of surgical guidance systems is relatively low. However, according to Dr. Culbertson’s analysis, if a surgeon is performing safe surgery, providing patients with top-quality outcomes, and advertising a competitive price, chances are that he or she will still turn a profit after the purchase of these technologies. n

William W. Culbertson, MD
• Lou Higgins Professor of Ophthalmology and Director of Cornea Service and Refractive Surgery, Bascom Palmer Eye Institute, University of Miami, Florida