The ophthalmic technology flood
Today, a visit to the commercial exhibitions of major meetings is a real show, with companies’ booths offering amazing high-tech devices that promise to address the specific needs we have in our practices. Although such technology impresses us, we seldom receive information on the evidence-based data surrounding its effectiveness, its cost-benefit analysis and the potential for obsolescence.
Today, a visit to the commercial exhibitions of major meetings is a real show, with companies’ booths offering amazing high-tech devices that promise to address the specific needs we have in our practices.
Although such technology impresses us, we seldom receive information on the evidence-based data surrounding its effectiveness, its cost-benefit analysis and the potential for obsolescence.
In the past, clinical demands were met by simple market demand. Today, this formula is inverted: the industry supplies us with technology or instruments that they suggest we use for specific conditions or surgical procedures, despite nobody having demanded it.
Companies try to create a market. For example, when Steve Jobs created the iPad, initially, nobody understood what it was going to be used for.
There are many ophthalmic examples of this invasion, or ‘flood’ of inadequately proven technologies. The most relevant of all is femtosecond laser-assisted cataract surgery, which, in spite of the huge interest raised and, indeed, the amazing amount of technology that has been incorporated1, to date, has not demonstrated any particular value to our patients2,3.
Conversely, it results in a negative cost benefit for the surgeon4,5,6, who has to invest a large amount of money without-as is the case in many countries-a clear return.
Another example is the marking devices for toric lenses and intraoperative ocular aberrometry, which provide a sophisticated link between the corneal topographer and the new intelligent (so-called) microscopes, in order to obtain an adequate alignment in the IOL.
So far, no prospective clinical study has been published demonstrating any particular difference in the outcomes obtained by these devices versus the conventional ones, and yet the cost of one technology compared with another is overwhelming.
Too much
I believe we are oversupplied by technology, the capabilities of which have made it possible for the industry to suggest applications, innovations, instruments and other devices that purport to help us in our performance.
The cost of this falls on the surgeons and institutions investing in them. Unless healthcare systems provide extra payments for procedures such as astigmatic keratotomy with femtosecond lasers (which is no more successful than diamond knife incisions), then surgical teams lose out.
It is probably time to return to our real needs. Industry and physicians should work together to satisfy demands with real, effective tools. In a global environment in which healthcare costs are mounting, it is our obligation and that of the industry to establish the needs of expensive technologies that have relatively short obsolescence periods and give no clear benefit to our patients.
The industry should create consultancy groups, cooperating with them in order to establish, on a preliminary basis, which innovations are really relevant, while those that are just prototypes with potential benefits should be adequately studied.
Scientific ophthalmic societies should take charge of this endeavour as well, in order to provide clarity without commercial bias, and so give real guidance on this issue.
References
1. Ashok G, Alió JL. Femtosecond laser techniques and technology. Jaypee Brothers Medical Publishers; 2012.
2. Alió JL, Abdou AA, Puente AA, Zato MA, Nagy Z. Femtosecond laser cataract surgery: updates on technologies and outcomes. J Refract Surg. 2014;30:420-427.
3. Alió JL, Soria F, Abdou AA, Peña-García P, Fernández-Buenaga R, Javaloy J. Comparative outcomes of bimanual MICS and 2.2-mm coaxial phacoemulsification assisted by femtosecond technology. J Refract Surg. 2014;30:34-40.
4. Abell RG, Vote BJ. Cost-effectiveness of femtosecond laser-assisted cataract surgery versus phacoemulsification cataract surgery. Ophthalmology. 2014;121:10-16.
5. Popovic M, Campos-Möller X, Schlenker MB, Ahmed II. Efficacy and safety of femtosecond laser-assisted cataract surgery compared with manual cataract surgery: a meta-analysis of 14 567 eyes. Ophthalmology. 2016;123:2113-2126.
6. Alio JL, Soria F, Abdou AA. Femtosecond laser assisted cataract surgery followed by coaxial phacoemulsification or microincisional cataract surgery: differences and advantages. Curr Opin Ophthalmol. 2014;25:81-88.
E-mail: jlalio@vissum.com
Dr Alió is professor and chairman of ophthalmology at the Miguel Hernandez University of Alicante, Spain, and founder of Vissum Corporation, Spain. Dr Alió is a member of the Ophthalmology Times Europe Editorial Advisory Board. Dr Alió did not indicate any proprietary interest relevant to the subject matter.
