Review of the year 2013: Cataract and Refractive 2013

An update on FACS

Not necessarily la revolution!

Prof. Franchini summarized, "Today, FACS is a safe procedure that allows surgeons to perform precise incisions, capsulotomy and only partially efficient fragmentation of the nucleus, however, it is not safer, better or more precise and efficient than manual cataract surgery performed by a good surgeon. Furthermore, we must consider the price tag."

Challenging price tag

Although this is seemingly a 'hot topic' all our experts were in agreement that the price tag is creating a challenge for implementation in everyday practice. "The biggest challenge for me this year has been looking at how to introduce FACS in my practice, as financially it is difficult to be a viable option and the extra costs associated with this surgery cannot be covered by the patients currently," asserted Professor Alió. "A financial model is totally lacking, or at least it is in my country."

In agreement Prof. Franchini said, "Price must be a consideration, especially in these times of economic instability. The fact is that this procedure costs around $600–700 more per treatment!" This financial burden was also noted by Professors Shah and Grabner who have been trying to implement FACS into daily routine practice. "If the price tag was in the same range as that for phaco machines, every surgeon would be using FACS," stated Prof. Grabner, who believes that it will take around 3–5 more years before we will see affordability within FACS. Prof. Shah commented, "The business model for FACS is multifactorial but at present, the costs are high and financial gains are slow. However, it is an effective marketing tool!"

In Prof. Alió's opinion there is still a long way to go before this technology will become affordable. "Femtosecond lasers have to further develop to become truly multipurpose, capable of performing flaps or cataract surgery," he said. "This is technically challenging but it will be the only way in which we can introduce them in cataract surgery, for which femtosecond technology has a very difficult financial model."

Some considerations

Prof. Franchini underlined, however, that this technology is still in its first generation and although it is not known whether it will represent the future of cataract surgery, its advancements are still impressive. "Other revolutionary technologies, such as ultrasonic phacoemulsification and excimer laser, weren't at such an advanced state of improvement in their first generation forms," he asserted.

However, there is no escaping the financial impact of this technology, which was the shared voice of all our experts. "In my opinion," concluded Prof. Alió, "FACS is imbalanced concerning cost effectiveness and a financial model is proving difficult in order to be able to implement this technology into real clinical practice, on top of that it has not yet really proven to be the revolution that we all expected it would be. Time will surely tell us how we will be able to effectively use FACS."