Each year, about 3 million Americans go under the knife to have cataracts removed. But a Baltimore-based ophthalmologist will soon be wielding a computer mouse as he performs cataract surgery.
Dr. Scott LaBorwit, who owns Select Eye Care, an ophthalmology practice with offices in Columbia, Towson and Baltimore, owns one of approximately 50 cataract lasers in the U.S., and the first in Baltimore, according to Bill Hutchings, an official with Alcon, the provider of nearly all the cataract lasers in the U.S.
Because the technology is still new, there isn’t enough evidence to say definitively that the laser is preferable to traditional cataract surgery performed with a blade, but some experts say the procedure could have advantages.
A cataract is when the lens of the eye, which is behind the pupil, becomes cloudy. That can cause problems including blurred vision, sensitivity to light and difficulty seeing at night. In cataract surgery, the affected lens is removed and replaced with a prosthetic.
In traditional cataract surgery, an ophthalmologist takes measurements of the eye in advance and uses them as a guide while wielding a knife to make a 2-millimeter incision into the cornea (the outer layer of the eye) while peering through a microscope.
The surgeon goes through the incision to reach the lens, which sits in a membrane that the surgeon must also cut into, and uses ultrasound energy to break up the cataract. After the pieces of the cataract are removed through the incision, the surgeon places the prosthetic where the lens used to be.
With laser surgery, the surgeon views the eye on a computer screen instead of through a microscope, and with a few clicks of a mouse directs the laser to make the incisions, taking measurements in real time.
The laser helps to break up the cataract, so less ultrasound energy is needed.
LaBorwit said he was initially skeptical of the benefits of the laser, but was impressed by its potential when he saw it in action.
“I went out to San Diego to look at the laser at the national convention, and took a good look at it, used it, and came back from the meeting saying ,‘There is no question that this technology is going to revolutionize cataract surgery,’” he said.
Dr. David Chang, president-elect of the American Society of Cataract and Refractive Surgery, said there may be theoretical benefits to the laser, but that it is very controversial because the technology is still so new.
Cataract lasers have only been in use in the U.S. since 2011.
“Like any operation, a lot of work is going into new technologies that might have the potential to make things better, and the laser has that potential, but right now it is too early to tell what the benefits are, if any,” Chang said. “If patients need cataract surgery, they should not worry that it needs to be done with the laser.”
Chang also said that cataract surgery is already extremely safe. Only 2 percent of the 3 million cataract surgeries performed in the U.S. each year result in serious complications, he said, describing that as one of the best success rates of any medical procedure.
LaBorwit said he can’t afford to use the laser for normal cataract procedures because Medicare, along with most health insurance companies, will only allow a surgeon to receive around $700 per eye for cataract surgery. He is not allowed to charge the patient directly for the additional amount he would need to cover the costs related to using the laser.
That’s why LaBorwit will only be using the laser to perform cataract surgery that also corrects for astigmatism, because he can bill the patient an additional fee for correcting astigmatism. Astigmatism is when the cornea is curved in such a way that a person needs glasses.
“Cataract surgery now is an opportunity to not just see better, but to get freedom from glasses, and that’s what this is all about,” LaBorwit said.
During this procedure, in addition to removing the cataract, the surgeon uses the laser to make additional incisions in the cornea that correct for the curve. In some cases, the surgeon may use a special prosthetic lens to replace the cataract that corrects for the astigmatism, rather than making incisions in the cornea.
However, even when the astigmatism is corrected, patients may still need glasses to see things up close. For total freedom from glasses, a more advanced — and more expensive — prosthetic is used, called a multifocal lens. This lens provides improved vision at a distance and at close range.
The cost for this procedure with LaBorwit is the allowable amount of around $700 per eye for the cataract surgery, plus a $1,150 per eye — which is paid by the patient — for correcting the astigmatism. If a multifocal lens is used, the out-of-pocket fee is $2,950 per eye.
LaBorwit is scheduled to perform his first surgery with the laser on April 11 at the Baltimore Eye Surgical Center, where he performs all his surgeries.
In December, Labor wit is scheduled to open a 10,000-square-foot clinic, the same size as all three of his current offices combined, that will include a surgical center where he will use the laser. The clinic will be in The Wellness Center of Howard County, a 40,000-square-foot facility under construction in Elkridge near the intersection of Routes 100 and 103.
LaBorwit’s Columbia office will close once the new clinic opens.