The doctors at Slade & Baker Vision focus on achieving excellence in the field of ophthalmology. Excellence at our Houston eye center is achieved by insisting on the highest standards of operations and performance. Patients from all around the world seek the professional ophthalmology and LASIK eye surgery services of Stephen Slade, MD, FACS. Aside from pioneering LASIK eye surgery, Dr. Slade also has the longest experience with Bladeless LASIK or LASIK performed with the Intralase method. LASIK Eye Surgery pioneer Dr. Stephen Slade is a Houston, Texas native who is a specialist in vision correction. Dr. Slade has extensive experience and has performed LASIK and other types of refractive surgery on more than 25,000 patients from Houston and around the world.
LASIK eye surgery using Intralase (sometimes called IntraLASIK) has been performed by Dr Slade and his staff longer than any other eye care practice in the United States and Houston, Texas. In fact, we have the Nation’s longest experience with the laser keratome, since 1998. In regular LASIK a blade is used to make the flap, with IntraLASIK a laser does this step. For many patients it may be the best choice. In addition, the laser microkeratome offers unique safety factors. The Intralase technique uses a laser to precisely, more safely create the LASIK flap. If you are seeking LASIK in houston why not choose the most experienced surgeon with the safest LASIK technology available.
Meet Our Doctors
LASIK and other forms of laser eye surgery and refractive surgery require skill and experience. Dr Slade has experience with many refractive surgery techniques and offers them here in Houston, Texas. This helps you because you are not squeezed into a “one size fits all” operation. Dr Slade was the first doctor in North America to perform LASIK. Dr. Slade was also the first doctor in North America to implant the accommodating IOL, the crystalens for presbyopia or difficulty with reading vision. We also have the nation’s longest experience with all laser LASIK where no blades are used. He has performed tens of thousands of refractive surgery procedures on patients from Houston, Texas and around the world.
Stephen G. Slade MD, FACS and Richard N. Baker OD have practiced together since 1983. In 1995 they founded the Laser Center of Houston as a referral clinic for patient care, physician education and as an investigational site to advance the art of refractive surgery. They head a multilingual team of technicians, many of whom have had refractive surgery themselves at the center. They were the first in the North America, along with Doctor Stephen Brint of New Orleans, to perform LASIK and have directed the training of most of the surgeons now doing LASIK in the United States. Many of these same surgeons have chosen Doctor Slade for their own surgery. Indeed, Doctor Slade is the “Doctor’s Doctor”, over 400 eye surgeons have chosen us for their own refractive surgery.
We now have the best options that we have ever had to address each patients’ particular refractive error. We are certainly excited about our continued work with LASIK, and our advanced scanning Technolas laser, the first in the United States, as well as our new Wavelight laser, the fastest laser available in the United States. We now offer intraocular lenses and “permanent contact lenses” which may be the best option for some patients. We continue to lead the way in new procedures with the laser microkeratome, the first modern inlay procedure in North America and the first accommodating intraocular lens for presbyopia to avoid reading glasses.
We continually try to maximize our outcomes and minimize the chance for complications. We plan to always offer the latest technology and most advanced surgery to help you achieve your best possible vision. We believe the more you know about refractive surgery, the better your experience will be. We want to help you make your decision as informed as possible and in your own time. We hope this information will help. Please ask us whatever questions you wish and continue to educate yourself about this technology. Please remember that refractive surgery is elective surgery. The final choice whether to have surgery must be your own. Modern refractive surgery can provide very good results with a minimum of complications, but there will always be some risks. More on Dr. Slade and Dr. Baker below.
Dr. Stephen Slade
Stephen Glenn Slade, a specialist in Presbyopia correction, cataract surgery, LASIK, Inplantable Contact Lenses, and refractive surgery, is a Houston native whose private practice is in Houston, Texas. He attended Tulane University and the University of Texas Medical School with a final, elective year spent at Guy’s Hospital, London, graduating umma cum laude, with highest honors.
He completed a residency at the LSU Eye Center in New Orleans and fellowships in corneal surgery at Baylor College of Medicine in Houston and in New York, New York on Project ORBIS. Dr. Slade is a Fellow of the American Academy of Ophthalmology and the American College of Surgeons. He is an active teacher of surgical techniques and has taught, lectured to, and certified over 8,000 surgeons LASIK and lamellar refractive surgery.
In 1991, along with Stephen Brint MD, he performed the first LASIK in the United States. Later he performed the first Custom LASIK ablation based on topography in the United States. He has since done tens of thousands of cases.
Dr. Slade has remained on the cutting edge, having the nation’s longest experience with all laser LASIK, accommodating iols (crystalens) and implantable contact lens. In fact, Dr. Slade was a lead investigator and presented the data to the FDA for panel approval for both the crystalens and the implantable contact lens. Of unique note, Dr. Slade is considered a “surgeon’s surgeon”. Over 450 of his fellow eye surgeons have chosen him to for their own eye surgery. He is an active researcher and the U.S. medical monitor for several new technologies including the Intralase laser for All Laser LASIK, the implantable corneal contact lens, and the Wavelight laser . He has received numerous awards including 11 named lectures, Refractive Surgeon of the Year, two China Service Medals, the Summit Technologies Pioneer of Refractive Surgery Award, the Casebeer Award and the Lans Lectureship.
In 2007, Dr. Slade received the Barraquer Award, the high award from the largest society of refractive surgeons. The Barraquer Award is given only once a year to one doctor in the world. Dr. Slade was selected by his peers for both “Best Doctors” and “Best Doctors in America” and has received the Honor Award of the American Academy of Ophthalmology. He is a regular presenter at medical meetings and has received several “Best Speaker” awards and has twice won First Place at the American Society of Cataract and Refractive Surgery Film Festival. He has served on several Editorial Boards including the Journal of Refractive Surgery.
Dr. Slade has produced many articles, book chapters, holds four patents or patents pending in the field and has authored five textbooks on refractive surgery. He has been featured in numerous news segments aired on CBS, ABC and PBS as well as numerous national affiliate stations. Dr. Slade has been quoted in the New York Times and the Wall Street Journal as well as numerous local press stories. Dr. Slade was the featured surgeon on the Emmy Award winning PBS documentary “20/10 by 2010?” narrated by Walter Chronkite.
Dr. Slade is the first in the United States to use the latest technology for cataract removal, the Femtosecond Laser. This high speed laser actually does several of the steps of cataract surgery that are now done by hand. We believe this will add precision and safety to the procedure. The results of this technique were presented at the largest meeting on cataracts, the American Society of Cataract and Refractive Surgery in April, 2010.
Dr. Richard Baker
Dr. Baker lectures extensively on refractive surgery practice and co-management both in the US and internationally. He has taken care of more refractive surgery patients during the critical pre and post-operative phase than perhaps anyone in the US.
Dr. Baker is an active course instructor for LASIK courses. He has been a co-investigator for Summit Laser and has collected patient data for PRK, PTK and LASIK. He has taught refractive surgery nationally and internationally including China, Mexico and the Carribean. Together, Dr. Slade and Dr. Baker direct the certification courses that are required of doctors to perform LASIK, training almost of the doctors currently doing LASIK in the United States.
Dr. Stephen Slade and Dr. Richard Baker specializes in services such as:
LASIK is a laser eye surgery procedure that can improve your vision and quality of life. A key factor in the LASIK outcome is the surgeon. But, most patients in Houston and elsewhere chose a LASIK surgeon based on one or two anecdotal reports. They research a new car purchase more. Other surgeons and LASIK specialists know who to go to. These doctors simply ask their colleagues, read the literature and see the leaders lecturing at meetings. Dr Steve Slade is a LASIK specialist that is indeed a surgeon’s surgeon. He has performed laser eye surgery and refractive surgery on more than 450 other ophthalmic surgeons and hundreds more from other medical specialties. These patients come from not only the Houston and southeast Texas area, but from many other countries.
Learn more about LASIK:
LASIK, as in any other major surgery, has risks. For more Information, please call (713) 626-5544 .
Welcome to the Cataract Surgery Center of Slade & Baker Vision Center. If you suffer from cataracts or have lost the ability to see up close, you have come to the right practice. Drs. Slade and Baker are pioneers in the field of refractive cataract surgery. Our patients not only have the choice to see at all distances after surgery they are the only patients in the United States that can have Bladeless Laser Cataract Surgery.
Bladeless Laser Cataract Surgery was first performed in the United Stated by Dr. Stephen Slade within our office surgical suite. Bladeless Laser Cataract Surgery uses the femtosecond laser to do many of the steps currently performed by hand, and is designed to provide a greater level of precision and safety to modern cataract surgery.
“I have been involved in many new technology introductions, and I know from these past experiences that Bladeless Laser Cataract Surgery, will be widely accepted by surgeons and demanded by patients all over the world,” said Dr. Slade after the procedure. “This is the cataract surgery that I would want for my friends, my family and myself.”
- Understanding Cataracts
- Bladeless Laser Cataract Surgery
- About Cataract Surgery
- Multifocal IOL Implants
- Toric Lens Implants
- Accommodating IOLS
Report: First cataract surgeries performed with femtosecond laser in the U.S.
By Stephen G. Slade, MD, Houston TX
During the last week in February, I had the privilege to be the first ophthalmic surgeon in the United States to perform cataract surgery using a femtosecond laser. The procedures that we performed over a 2-day period with the LenSx Laser (LenSx Lasers, Inc., Aliso Viejo, CA) are the beginning of what I believe will be the next evolution in refractive cataract surgery.
The LenSx Laser received FDA clearance for anterior capsulotomies in August 2009 followed by a clearance for corneal incisions in December 2009. During these first surgeries, we used the LenSx laser to create the anterior capsulotomy and corneal incisions for the cataract procedure. Future clearances will allow us to expand the use of the LenSx Laser to include the remaining steps in the surgical process, with the exception of irrigation/aspiration and lens insertion.
Procedure and Patient Acceptance
We performed the first surgeries at our ambulatory surgery center here in Houston with the second laser the company has manufactured. The surgeries turned out even better than I expected. We have done 8 cases and all were 20/25 or better at day one. All of the capsulotomies attempted were perfectly centered and achieved diametric accuracy of ± 0.25 mm. Precise corneal incisions were effectively created by the laser, and all were self-sealing postoperatively. After cataract removal using phacoemulsification, all of the eyes underwent premium IOL implantation. Although anecdotal, both my partner and I independently felt that the corneas at day one were exceptionally clear, perhaps because there is less maneuvering with the corneal tissue and intraocularly.
As exciting as the performance of the LenSx Laser was, the overwhelming response from patients was even more impressive. Then again, patients have always thought that cataract surgery was done with a laser – so perhaps this helped to overcome any concerns about being the first patients to benefit from this new technology. I believe patients will benefit from a lower complication rate and from improved refractive results. The ability of the laser to make reproducible corneal incisions and capsulotomies will allow us to optimize the lens position and astigmatism now. In the future we will be able to make corneal astigmatic incisions to deal with preexisiting or induced cylinder.
I do believe femtosecond refractive surgery will become the preferred method of cataract surgery. This will be both surgeon and patient driven. Patients are extremely excited about “laser cataract surgery”. The “get it”. Surgeons will find it more precise, reproducible and simply more “fun”.
The initial clinical evaluation of the LenSx Laser began in 2008 with Professor Dr. Zoltan Nagy of Semmelweis University in Budapest, Hungary. He has now successfully performed over 500 surgeries with the LenSx Laser, and the first image-guided refractive cataract surgeries with the laserin December 2009. This surgery included lens fragmentation, capsulotomy and corneal incisions.
My initial experience with creation of the capsulotomy and corneal incisions has been extremely positive. In my years as a refractive and cataract surgeon, I have had the good fortune to be involved in the introduction of a number of new technologies – including the first customized ablation for LASIK and the femtosecond laser for corneal flaps – without a doubt, these first surgeries were as textbook as you could hope to have.
In the past 15 years, there have been a number of attempts to deliver a laser for cataract surgery.With the LenSx Laser, I believe that we may be on the way to having a cataract technology that allows us to deliver technique that matches our premium IOLs, enabling us to deliver even better outcomes.
The Advantages of Laser Cataract Surgery – By Stephen G. Slade, MD
What excites me the most about femtosecond laser-assisted cataract surgery are the benefits that the technology offers to our patients. Safety will be enhanced by reduced phaco time and power, less surgical time in the eye, and finer, more elegant incisions, among other innovations. Precision may be increased by an exactly sized, shaped, and positioned capsulotomy that will better control the IOL’s final resting place as well as by precise, reproducible primary incisions and standardized, quantifiable astigmatic keratotomies. Femtosecond lasers could also enable and make possible many other technologies, including polymer IOLs that can be injected through a tiny capsulotomy.
Most of the heated debate about femtosecond laser-assisted cataract surgery has not been about the capabilities of the technology, however, but rather its real-world practicality. Will patients seek it out? Is it economical? Who will pay for it? I have a unique perspective here. I have been performing laser cataract surgery commercially in Houston for nearly a year now on all of our practice’s premium IOL patients and most of our other cataract patients.
Since LenSx Lasers Inc. (Aliso Viejo, CA) delivered the platform to us in February 2010, we have not been part of an FDA trial or subject to other investigational device restrictions. The laser already had 510(k) clearance for anterior capsulotomy when we received it, and clearance for incisions and lens fragmentation quickly followed. In my experience, patients easily understand and prefer “laser” cataract surgery, and they seek it out. Yes, there are added costs. This advanced technology is not covered by Medicare, however, so patients can assume these costs if they so choose. In other words, patients can elect to pay for what they decide is better care, safety, and efficiency.
On January 1, 2011, the first baby boomers turned 65 and entered Medicare, with an estimated 10,000 hitting that milestone each day now. The US population over the age of 65 is projected to double in 7 years. I believe the development and availability of laser cataract surgery are right on time.
This piece was adapted with permission from Dr. Slade’s editorial “Thoughts on 2010”, which appeared in Cataract & Refractive Surgery Today’s February 2011 edition.
Stephen G. Slade, MD, is a surgeon at Slade and Baker Vision in Houston. He serves as the medical director for LenSx Lasers Inc. Dr. Slade may be reached at (713) 626-5544; email@example.com.
For complete details about Laser Cataract Surgery, please call (713) 626-5544.
Near Vision Solutions
Slade & Baker Vision Center specializes in helping patients see young again by providing them with a full range of vision without glasses or contact lenses. This can be accomplished with contact lenses, laser vision correction or with Intra Ocular Implants.
If a person had normal vision when they were young, they could easily shift their focus from near objects to distant objects, seeing clearly at all distances. But around the age of 40 – 45, the lens inside the eye begins to lose its ability to change focus and most people become dependent on reading glasses or bi-focal lenses to see close objects. This condition is called presbyopia.
One of the Near Vision procedures we perform is called monovision or blended vision. Monovision is created when one eye (usually the dominant eye) is corrected for clear distant vision while the other eye is corrected for clear near vision. The visual cortex of the brain learns to only pay attention to the image that it wants to see in focus and ignore the image that is not in clear focus. Most people who have monovision are able to see well enough at all distances to do things at any age without corrective lenses.You may be using this now with contact lenses. If so, you can likely have the same correction with LASIK.
In a person who is nearsighted and around the age of 40 – 45, correcting both eyes with LASIK or PRK to see clearly for distance vision means they would probably become dependent on reading glasses to see up close unless they have the monovision procedure.
For slightly older patients around the age of 55 – 60, the lens inside the eye is usually showing signs of cataracts. For this age group, removal of the natural lens inside the eye with a procedure called Refractive Lens Exchange (RLE) can be a better alternative to laser vision correction. After the natural lens is removed, there are a number of Intra Ocular Lens options that can provide patients with a full range of vision. These options include: monovision with monofocal IOLs or one of the more advanced multifocal or accommodating IOLs such as ReSTOR or Crystalens.
Patient who have significant cataracts are not candidates for laser vision correction. Instead, they should have cataract surgery to restore vision. The same IOL options are available to cataract patients as they are for refractive lens exchange patients.
Common Eye Diseases:
- Macular Degeneration
- Dry Eye
- Diabetic Retinopathy
- Corneal Disease
There are many types of contact lenses and many reasons to wear contact lenses.
At Slade and Baker Vision Center we offer: Soft Contact Lenses , Multi-Focal Lenses, Gas permeable Lenses, Synergeyes Lenses, a hybrid soft gas permeable, Plateau Lenses, and Wave Front Contact Lenses
Disposable Soft Contacts are the most popular, compatible, and the most economical. Options include single vision, toric, and bifocal to correct a wide range of vision problems. When vision cannot be corrected to an acceptable level with soft contact lenses, Gas Permeable Lenses can be customized to each patient’s refractive error. If comfort is a problem with Gas Permeable Lenses, we are a provider for Synergeyes Contact Lenses. Synergeyes Contact Lenses are a unique design of a gas permeable center with a soft lens skirt. This gives the comfort of a soft lens with the crisper vision of a “hard” lens. These lenses now come in a wide range of parameters to maximize both fit and vision and are customized and manufactured individually for each patient.
For patients who have unusual vision problems not correctable by standard type contact lenses whether from a corneal dystrophy, a previous corneal surgery, or corneal injury, we have Plateau Lenses. These lenses are individually customized design for unusually shaped corneas. Dr Baker helped with original design of these lenses for post Radial Keratotomy (RK) patients. Dr Baker has over 25 years experience fitting contacts for these type patients.
Slade and Baker are also providers of Wave Touch Contact Lenses. Wave Touch Contact Lenses are soft contact lenses with a unique in-optical design. These lenses are used for patients who want the absolute best vision available in a soft contact lens, patients who have had previous refractive surgery, or patients who have lenticular astigmatism. Lens parameters are selected for fit by a trial lens method. Then a Wavefront Map is taken over the lens while on the eye with the Tracey Aberrometer. The lens is manufactured with the prescription from the wavefront map to include correction for lower order and higher order aberrations.
We can also provide trial contact lenses for patients who want to try monovision. If you are considering monovision as a refractive procedure such as with LASIK or monofocal IOLs, trying it out first with contacts is usually a good idea.
Contact lenses can be used for both cosmetic and therapeutic purposes. Contacts can also offer advantages to athletes and younger patients who are not ready for refractive surgery. Older patients who do not want to wear bifocal glasses also benefit from contact lenses.
Advanced contact lens technology can now correct Astigmatism, Nearsightedness, Farsightedness, Presbyopia, or any combination of these refractive errors.
They can also be used in the treatment of Keratoconus. Other uses include correcting vision after a corneal transplant and bandaging the cornea after PRK.
There are a number of keys to wearing contact lenses successfully:
#1 MOTIVATION: Ask yourself why you want to wear contact lenses. Is it to look better, to see better, or to reduce your dependence upon glasses? Whatever the reason contact lens patients have to be motivated and have realistic expectations. Finding the ideal contact lens for you may take several tries and adjustments. Lenses selected and worn in the office for 30 minutes may feel different after several full days wear. The actual shape of your cornea can change after wearing them for a while. Blink patterns and tear film can change as patients adapt to wearing contacts. If you understand there is always a bit of a trial and error method to obtain the best fit, chance are you will be a successful contact lens wearer.
#2 REFRACTIVE ERROR: The type of refractive error you have can influence your chances for success. Some refractive errors can be corrected with basic or standard lenses. More complex errors may require more complex or specialty contact lenses. Your initial exam will determine if your refractive error is simple or complex and where it is located (cornea or lens inside the eye). Corneal dystrophies, corneal transplant, and post refractive surgery patients are always more complex but we can usually obtain success with one of the many new technology contact lenses available at our offices.
#3 COMPLIANCE: How well patients comply with recommended handling, cleaning, storage, replacement and the prescribed wearing schedule has a significant influence on success. Lenses must be clean to perform their best and eyes are more tolerant to a consistent wearing schedule.
#4 HYGIENE & ENVIRONMENT: Hygiene and environment also have an influence on success. Lid hygiene can affect the chemistry and production of tears necessary for hydration and comfort. Patients with blepharitis, meibomanitis, or other lid abnormalities can affect the secretion of the oil glands that keep our tears from evaporating too quickly. Contact lenses become soiled more quickly if the eyes are dry. Patients who have dry eye can be treated prior to contact lens fitting to improve their chances for success. Wet, lubricated lenses don’t get soiled as quickly. As we age, our eyes have a tendency to become drier and many previously successful CL wears may lose their compatibility with contact lenses. Many of our patients regain their success with contacts by improving their “dry eye” symptoms with therapy. Many contact lens failures however, are able to experience success with refractive or intraocular lens replacement surgery. We can evaluate and recommend your best option if your contacts can no longer be tolerated.
#5 FIT: Physical fit of the contact lens and its alignment and movement when blinking is important in providing tear exchange under the contact. This provides oxygen to the cornea for normal metabolism and eliminates debris and bi-products. There are many different manufactures of contact lenses with many different designs, materials and fitting characteristics. Our state-of-the-art equipment in measuring the dimensions of your cornea allows us to select the very best fit for you.
The Fitting Process
Our pre-fitting exam and assessment includes: corneal topography; corneal curvature; refraction; tear testing (volume and chemistry); blink pattern; lid anatomy; pupil size; intraocular pressure; binocular vision; wavefront testing; dilation; retinal exam; trial lens; discussion of expectations; and for current or previous CL wearers an evaluation of previous or current lenses.
If your test results are good and we determine you are a good candidate, most types of lenses can be dispensed to you the same day from our inventory. If a customized lens is necessary it will need to be ordered and dispensed back in our office upon delivery. We will provide you with instructions on handling cleaning, and inserting and removing your contacts at the time of dispensing.
Patients are usually asked to return to the office a week or two after dispensing the contacts for evaluation of compatibility, wearing schedule, fit, quality of vision and performance within the eye. Adjustments to the contact lenses are made when indicated at no additional cost during the fitting period.
Speaker: Thank you very much. It’s really a pleasure to be here talking in front of this group again. My topic is refractive cataract surgery. I had the good fortune over three years ago to get the first Femtosecond laser for cataract surgery in the U.S. I’m corneally trained. I have done a lot of refractive surgery so that really sort of fit in.
I want to cover four things with this. I want to cover why this is important. I want to cover where it is today. What would slow it down and what would accelerate our growth together? Now, why is it important? Here’s the best demonstration of that. How many of you have had or will had cataract surgery? Raise your hands. We all have a stake in this.
Most of us, a lot of us, if you were born between 46 and 64, you’re a baby boomer. It’s this huge demographic that drives everything. More than 10,000 turn Medicare age every single day. In eight
years, the number of people over 65 will double in the United States. It’s just absolutely gigantic. It’s this population. You know the boomers. I am a boomer. A lot of us are boomers. It’s this Botox, Viagra, collagen, Restylane generation. We view aging as weakness. Admittedly, we have unrealistic
expectations. Google “baby boomers.” Twenty five million hits in 0.26 seconds. It’s really pretty amazing.
Not only that, but if you look at the baby boomers, we control 80% of the individually-owned money in the United States. Private-owned money, we have 80% of it. We drive a patient-pay market which is
also projected to grow dramatically. Just demographics alone, can you imagine what our market is going to do? It’s not just the total numbers. If all we did was sit still, you’d have twice as many cataract patients as ophthalmologists in our chairs.
Think about the other things. It’s not just the percentage that reaches that age. It’s percentage of that population that decides to have surgery. With hyperopia becoming more treatable by lens exchanges, myopia, better lenses certainly for presbyopia. Now we’re driving down deeper into that patient population. We might be phasing a 2.5 or even a 3X. The first time, we’re starting to talk about fixing lenses, not only for their clarity, but also for their function.
Now, admittedly, there’s always going to be some people that just want whatever the government provides. I understand that. They will not be premium [channel 3:12] candidates. In Texas, we have a lot of immigrants from California that come in wanting just whatever their government provides.
Let’s take a look at refractive cataract surgery and laser- refractive cataract surgery and see what the current state is. Premium IOLs, this premium channel, is growing. People are realizing the benefits, our patients. There are a couple of peaks here and there, but not only in [torricks 3:43] but in presbyopia correcting and in total, it’s growing.
If you survey the doctors that have started using Femtosecond laser cataract surgery, they’ll tell you that the laser drives volume. They’ll tell you that they have increased their percentage and penetration of premium IOLs with that laser. They’ll also tell you that they’re able to charge more for that, some $800.
Where is it? Best count today, over 400 lasers in 52 countries, well over 100,000 procedures. It’s passed the test of real-world success, in my mind. You have thousands of surgeons doing tens of thousands of cases. Certainly the gold standard is an FDA trial, but that’s tens of
surgeons doing hundreds of cases.
Where else is it? Well, there are some 70 peer-reviewed publications now, if you look at PubMed, on this particular topic. That’s different. There are books. There are at least three books out. Well, if you can read this slide, we can spend some time on this, actually. Some of my favorite papers are on this. We can get some handouts. I like line 7, Femtosecond laser capsulotomy “Journal of Cataract and Refractive Surgery.” Any questions on that? That really is. No kidding, that’s a lot for a relatively new field. That’s been examined in both ways that are sort of reality-based and also in science. Again, certainly has withstood the test of time.
What I was talking about when everything froze was the books that have been published and the next slide, is no surprise now, was going to be a picture of… There we go. It’s hard to promote your own stuff at this meeting. I would just like to ask, if it’s not quite that difficult. I wasn’t the only person on this book. You can see there were a lot of people on this book. Anyway, enough shameless promotion. I’ll never do that again.
We discovered early on that we had better results. We had more control of the lens position in the eye with crystal lens compared with Femtosecond laser cataract surgery. We also found the same thing with our ReSTOR IOLs. An overlooked aspect of this is the imaging. This has been and
will continue to be a vital part of Femtosecond laser cataract surgery.
On the billing side, recently, CMS, last year, allowed us to bill for the imaging portion of this procedure. That’s a huge win. Why is this important? It’s important because I can go into the OR now
knowing how thick a lens is, how thin a lens is, and how dense it is. If you know the parameters of a lens, the measurements, and if you know how dense it is, then you can get a workload. You can compare that to how much phaco it takes and now you can start talking about developing a nomogram. As a surgeon, and as a potential patient one day, I think that’s good news for all of us.
Let me give you another example. This is the SoftFit PI, of course, from Alcon. It’s a quicker, easier docking. It’s a higher performance. It was iterated after the Femtosecond laser was produced, the LenSx. It’s an excellent example of continuing innovation after the introduction. We have these small technology companies that had been acquired by larger companies. They kept the scientists. They’ve been well-funded and well supported. What we have today won’t be as good as what we have tomorrow. That’s a wonderful thing.
We also have devices that we can measure. Anyway, this is actually the Clarity device and what it is, is inter-operative aberrometry. It’s a neat, little small device that fits on the cornea. Here is another video if we can show this video. This is a great video. This is really one of my best. I can see it up here. What it shows is all the things Femtosecond laser cataract surgery can do that I can’t do as a surgeon. That’s very important. This technology allows you to do things that you cannot do by
hand. Make a perfect rexus, plan that rexus, a custom rexus. Make the segments so that you can split them up however you want. Pop up the lens. It was a great video.
Safety is so important. There is no doubt in my mind that in special cases like traumatic cataracts, dislocated lens, that it is already safer. If we look at this excellent article, and I know this is
difficult to see, but this is the Lawless and Roberts out of Australia. They compared this technology. Their series “multi doctor” to single center sites and multi sites of complication rates. They had as good or as low a complication rate as the very best single sites. That, as well, is a huge win.
What could slow our field down? What could slow us down? Downturn in the economy, downturn in R&D funds. As I said, in my mind, this needs to continue to iterate. Look at Excimer lasers, how much they’ve gone from, 5hz, no trackers, trackers to 500hz. It needs to be not perceived as disruptive for the patient. Certainly, it’s a disruptive technology. It also can’t be too disruptive for the doctor. It can’t really slow us down.
What could also slow us down? We need to have results that are LASIK-like. These are the results used in the ORA, which is from WaveTec, and you’re getting laser-like results, LASIK-like results when you’re using the laser to fix the cataract. Anyway,you’re getting results now, plus or minus a half, 92 percent. That starts to sound like a LASIK trial, doesn’t it?
What could accelerate the field? Well-financed companies’ R&D. Even better results. Maybe the inter-operative aberrometers real time will get us there. Integration with the other things we have. The
phaco emulsifier. Integration with diagnostics, imagery, surgical planning, refractive surgery flaps and certainly the FDA could accelerate this. I like the idea of using the laser of using the laser to talk to my phaco, to talk to my microscope, to talk to my diagnostic lane. I don’t want to do away with phaco, maybe less FAKO, but I don’t necessarily see the benefit of trying to replace one good technology with this particular technology. A system and integration, I think, is very appropriate.
I love the idea of flaps. Now, of course, this was started by the VICTUS Technolas which is now part of P&L, another well-funded, well-driven R&D company. It’s another good example of that. I didn’t
really quite get it until we started doing flaps with our LenSx unit just this year. This is another great video showing the flaps.
Now, what’s different about this flap? Well, it’s a 10 times more powerful laser and it’s image guided. If you could see this video, you would actually see how it traces within the cornea along. You can
see the flap being created on the OCT inside the cornea. Now think about that. You could now do a flap based on rather than based on the underside of a cone. You could do a custom flap, an individualized flap. The safety aspects of that are tremendous. They lift beautifully, as you can see.
What’s interesting is if you ask doctors what their biggest concerns are with laser cataract surgery, they’re financial and reduce efficiency and flow. If one device fixes both, I just have buy one
device. They’d probably still charge me two service contracts, but one device is better than two. If you can adjust this to where it really fits in your flow, that’s also another huge win.
Just to sort of wrap it up, my own commitment, I’m with Vance Thompson. Vance just opened up a couple of weeks ago, his new center. This is our center. We’re building a 23,000-square-foot center to address what we feel is a coming perfect storm of patients wanting LASIK-like results with their lens surgery. Placing this, figuring out where to put the device if they do flaps or cataracts or whatever.
The last thing I want to just mention about the FDA. I know Dr. Eydelman is here. I’ve had the fortune to go up several times to the FDA. They’ve always been a bright, hardworking group of individuals.
They’re tough. There’s no question about it. They do their homework meticulously and they have a process that they drive to us.
Recently, over the last year, we’ve had a couple of really good successes with the FDA. Many of you may know about the ACOS cross-linking trial. We have 100 sites and are projected to do some 20,000 eyes. Believe it or not, from the first phone call I made to FDA to get that started to the first patient treated was less than a year. We have another initiative with them. I’ll have to say that I have found them more than available, very fast, and genuinely looking to help.
Now, some years ago here, at an ASCRS meeting, I have to admit, I wasn’t always that successful with FDA. I know Malvina’s at this meeting. Malvina, I want to tell you. That was a costume. It was only a costume. I am not the devil, Malvina. The rest of us aren’t the devil. With that, I’d like to bring up Vance Thompson. Again, it was just a joke, it was just a costume, that’s all there was to it.
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