Proponents of femtosecond laser–assisted cataract surgery (FLACS) have talked for years about its improvements to the surgery, such as allowing more precise corneal incisions and capsulorhexis cuts, but the two big downsides have always been the added cost and time of a FLACS procedure. A new study finds that surgeons are improving on the latter setback, at least.

In an effort to test whether cataract operating room (OR) productivity improves with a femtosecond laser using a hub-and-spoke model—in which a single laser is used to prep patients sent to multiple ORs simultaneously— a team of English researchers found that the model was faster than conventional phacoemulsification surgery (CPS) and increased OR productivity.

This randomized, controlled study evaluated 400 eyes of 400 patients. Of the 400 operations, 299 were performed on designated high-volume theatre lists, where a hub-and-spoke FLACS model was compared with independent CPS theatre lists. Operative timing and OR utilization information was recorded. Differences in productivity between hub-and-spoke FLACS and CPS sessions were compared using an economic model.

The team found that the duration of the operation itself was 12.04±4.89 minutes for FLACS compared with 14.54±6.1 minutes for CPS, allowing total patient time in the OR to be reduced from 23.39±6.89 minutes with CPS to 20.34±5.82 minutes with FLACS. They note that there was no difference in OR turnaround time between both models. The researchers add that OR utilization was 92.08% for FLACS and 95.83% for CPS. The only downside, however, was that FLACS costs £144.60 more in the UK than CPS per case. In US surgical centers, the cost difference is likely to be even higher. 

Roberts HW, Wagh VK, Mullens IJM, et al. Evaluation of a hub-and-spoke model for the delivery of femtosecond laser-assisted cataract surgery within the context of a large randomized controlled trial. Br J Ophthalmol. 2018;202(11):1556-63.