Over the past few years, there have been many exciting developments in laser cataract surgery, and Dr. Stephen Updegraff believes these new advancements hold great promise for the future.
As a surgeon, Dr. Stephen Updegraff’s role is not just to perform surgery and treat patients – it’s also to remain heavily involved in the field of cataract and refractive surgery, and when new technologies emerge, to analyze them and determine whether incorporating them will be beneficial to the patient. Throughout his career, Dr. Updegraff has remained on the forefront of technologic advancements in LASIK and cataract surgery, and he carefully and personally vets each new advancement as it emerges. Once he determines a new advancement is beneficial and that it greatly improves the surgery and its results, Dr. Updegraff embraces and includes it.
Nearly a decade ago, the femtosecond laser emerged as a new advancement in LASIK surgery. Instead of using a handheld microkeratome blade to create a corneal flap, surgeons could now use a femtosecond laser – allowing LASIK to become a blade-free, “all-laser” surgery.
In 2004, Dr. Updegraff became the first surgeon in Tampa Bay to provide all-laser LASIK surgery. But before he felt comfortable offering this new technology, he thoroughly vetted it to ensure it was a beneficial addition to LASIK. Dr. Updegraff had closely followed the invention and testing of the femtosecond laser – even observing the first all-laser LASIK surgery performed in the United States. Once he determined that its greater increase in safety and accuracy made all-laser LASIK the best option for his patients, Dr. Updegraff adopted the new technology at Updegraff Vision.
When developments in laser cataract surgery began to emerge, Dr. Updegraff closely followed its advancements. He observed the first laser cataract surgery performed in the U.S., and then flew to Munich to use the technology himself – allowing him to personally vet it.
Dr. Updegraff remains very intrigued by the possibilities provided by laser cataract surgery, and believes that it holds great promise. However, before he offers this technology to his patients at Updegraff Vision, Dr. Updegraff wants to ensure it includes specific improvements, and that it has been definitively proven to be safer and more efficacious than cataract surgery performed without a laser.
One of the primary concerns Dr. Updegraff has with laser cataract surgery at this time is that there’s currently no peer-reviewed, scientific evidence proving its safety and accuracy. Until the appropriate studies have been performed and laser cataract surgery has been determined to be beneficial to the patient, Dr. Updegraff doesn’t feel comfortable offering it at Updegraff Vision.
Laser cataract surgery also requires much more time to perform – currently, laser cataract surgery takes 45-50 minutes, while cataract surgery performed without a laser takes just 5-10 minutes. In order to be demonstrably safer, Dr. Updegraff believes laser cataract surgery should not greatly increase the amount of time spent in surgery.
Laser cataract surgery is considerably more expensive than cataract surgery performed without a laser. Medicare recently ruled that surgeons can’t up-charge for the way a cataract is removed from the eye; according to the guidelines recently published by the American Academy of Ophthalmology, “Medicare Part B covers the cataract surgery and the implantation of a conventional IOL without regard to the technology used.” Because surgeons themselves increase their costs by performing laser cataract surgery – in addition to the cost of the half-million-dollar laser, they must pay a royalty fee to the laser manufacturer each time it’s used – the patient’s out-of-pocket charges increase. Can we currently justify this extra cost to the patient? Because there’s currently no proven difference in safety or accuracy between cataract surgery performed with or without laser technologies, Dr. Updegraff doesn’t believe we can.
Additionally, Dr. Updegraff believes many patients have misconceptions about laser cataract surgery – particularly the false notion that it’s an all-laser procedure. Even in today’s “laser cataract” surgical procedure, the surgeon must still use a blade to make numerous incisions.
All in all, the goal of laser cataract surgery is to make cataract surgery safer and more accurate. Dr. Updegraff believes laser cataract surgery is a fantastic technology that holds great promise for the future, but it hasn’t achieved this goal yet. Once further advancements can prove its benefits, Dr. Updegraff looks forward to incorporating this technology into Updegraff Vision.