I started using the femtosecond laser relatively late compared to the early pioneers of this technology. I hesitated at first because I thought that the femtosecond laser could be almost harmful to the eyes. Then I limited myself to thinking that it was a useless machine. To be a good surgeon, I should know how to perform a cataract surgery perfectly without needing the help of this machine.
Then slowly, I approached this technique and started performing the first operations in 2015. So now, 6 years ago and since 2016, I have switched my surgery.
For intrastromal ring operations, I only perform femtolaser because they give greater safety. In short, it is not possible to implant intrastromal rings with the traditional technique, in my opinion. While for cataracts, I began to perform most of the operations with femtolaser from 2016. It was the year of the turning point in which I decided to approach this new technique using femtolaser to perform in almost 100% of cataracts.
Currently, the percentage of cataracts that I perform with the femtolaser is close to 80 or 90%, so I would say that I am going towards 100%.
There are some particular characteristics that do not allow me to use the femtolaser so I opt to use the traditional way. But, I tend to use femtolaser in majority of my interventions.
This does not have a sole purpose of marketing and promoting technology in order to make patients spend more. Also because especially at the beginning, I deprived myself of using femtolaser and I did not charge my patients for this. So, I deprived myself of what could have been a gain for me, and I invested in learning how to use this technology. I’ve always done this and have told patients the absolute truth.
Now my cataract rates with the femtolaser are in line with those of the market. No more, no less, and, since a certain part uses the technology, the surgeon takes less. This is a difficult choice because a good anterior segment surgeon can and must perform cataract surgery without femtolaser. However, it is necessary to invest in new technologies and offer the patient the best that can be offered on the market.
We also keep in mind that cataract surgery with femtolaser is no easier than cataract surgery without it because you have to learn to communicate with the machine and use it to the best of what it can give, without running into errors that can happen by using it superficially. The femtolaser does not operate for the surgeon, but it is a machine that makes a small but very important piece of the operation, which the surgeon must know how to use well. There are also other phases that are traditional. Therefore, there is a phase in the surgery that is performed by this machine, which is to cut the lens, and then all the other phases are performed in a traditional way. The surgeon must be an excellent conventional surgeon, and in addition, he must be a technological surgeon who can use this type of machine.
I add the fact that my five years experience from the beginning of this path with the femtolaser has been articulated on 4 different machines. So, I think I am one of the few surgeons in Italy and Europe to use 4 different femtolaser. This isn’t easy at the beginning because each machine has completely different characteristics. Machine A is a portable machine, machine B is a stationary machine, machine C only does cataract, machine D does both cataract and cornea …
In short, each machine has particular characteristics. You have to adapt your brain according to the structure you are operating to make the most of that particular machine.
As I said, the use of 4 different machines allows me to have great versatility and, above all, to know all the strengths and weaknesses of the machines I use.