Want a laser without a big investment? Go mobile!

Lasers move from town to town

Two years ago, when new excimer lasers received government approval for use in correcting vision, ophthalmologist Robert I. Schnipper faced a quandary. Schnipper wanted to offer his patients in Jacksonville, FL, the new technology to perform the laser keratomileusis in situ (LASIK) procedure, which involves creating a flap in the cornea and reshaping the tissue beneath it. But the laser manufactured by VISX of Santa Clara, CA, costs more than $500,000. Would he be able to recoup his investment? Or would the laser become obsolete as updated models emerged?

His solution: Leasing a mobile laser that comes to his office twice a month.

Laser Vision Centers of St. Louis pioneered the mobile laser and received U.S. Food and Drug Administration approval for a unit that travels with a surgical suite on a vibration-free mounting system. It can be used for LASIK or another vision-correcting procedure: photorefractive keratectomy.

Physicians and same-day surgery facilities have a choice between using that mobile suite or having a technician install a laser for a day or two at a time. Either way, a factory-trained technician travels with the laser to provide routine maintenance.

It is a concept that has proved appealing to a growing number of physicians and surgery centers around the world, as Laser Vision grew from a few lasers in Canada in 1991 to more than 115 currently around the world. A Richmond, VA, hospital even sold its underutilized laser to Laser Vision to reduce the financial burden and then leased it back.

"I have all the advantages of my own laser and none of the disadvantages," says Schnipper. "The laser comes with an engineer. The machine is set up in my facility. It's fully checked out to factory specifications, and it works perfectly well. You do your cases, and it's gone at the end of the day."

While high-volume surgeons may prefer to have access to their own laser, the mobile laser is particularly appealing to small and medium-sized communities that otherwise would not have enough case volume to justify the expense of the technology, says Jack Klobnak, chairman and CEO of Laser Vision. "This makes it affordable for them."

Surgery centers or physicians pay a fee per case and must guarantee a minimum usage. For example, Schnipper agreed to perform at least 10 cases twice a month; usually, he says he performs many more than that. For competitive reasons, Klobnak declined to discuss the fee but said it is less than $1,000 per case. Schnipper charges $2,300 per eye for the LASIK procedure.

Most surgery centers choose to use a laser that is rolled into the OR or procedure room the night before the scheduled caseload, says Klobnak. A technician then sets it up as if it were a factory installation. "They have to go through all the steps they go through if it's a brand-new laser."

If the facility or physician's office doesn't have a room large enough for the laser and related equipment, they can use the MobileExcimer, which is a traveling surgical suite with a specially designed floor system carted by an 18-wheeler.

"It's almost like the laser floats on a cushion of air both in the truck and in the building [where it's installed]," says Klobnak. "When it gets where it's going, it's lowered on its own feet."

David Hardten, MD, FACS, director of refractive surgery at the Minnesota Eye Consultants in Minneapolis, performs LASIK at sites with permanent stationary lasers, temporary Laser Vision installations, and the mobile suite. The choice depends on the needs of each facility, he says.

"In a town where they don't have good access to an OR or a controlled environment, the mobile system provides a self-contained operating room," he says.

'You don't feel claustrophobic'

Patients walk into a waiting room, then move into a room where they undergo corneal topography, or a computerized mapping of the cornea. Air in the surgical area is controlled by special filtration, humidifiers, and dehumidifiers. There is also a clean-up room off the OR.

"It's actually bigger than some of the operating rooms I've done laser surgery in," remarks Hardten, who also is medical director for Laser Vision Center at Phillips Eye Institute in Minneapolis. "You don't feel claustrophobic."

Mobile lasers may receive more heavy usage than stationary ones and require frequent routine maintenance, notes Schnipper.

Still, he says: "I've never had to cancel surgery or reschedule surgery because of any problem. The laser has always worked to factory specifications. I firmly believe that their method of transporting it is fine. I feel very confident that the laser is working as well as if I owned it and kept it in place and it never moved."

Meanwhile, Schnipper feels comfortable knowing that the burden of keeping up with changes in laser technology rest with Laser Vision - not with him. "If a new generation of laser machines come out that are superior to the ones we have now, I have no doubt that Laser Vision will upgrade and get the new machines," he says. "I think it's a good deal."