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Technology innovation: Examining the tipping point With ongoing laser improvements, I hope to someday be able to assure patients that it is both more precise and safer than mechanical methods. Howev- er, we have not reached that point yet in my opinion. The moment that happens, another 25% will elect LACS. As an industry, we have not com- pletely tipped yet but we are very close. Clinicians can still become involved and gain the benefits of being early adopters. The risk of entry has decreased. Clini- cians now can rely on proven technol- ogies and platforms and opt for mobile and used options. If more surgeons commit to LACS, it signals to the industry that it should in- vest more in the technology to improve patient benefits. Conversely, the tipping point could shift faster if industry would invest more in these technologies at an earlier stage to increase the benefits of LACS compared with standard cataract removal, changing the fulcrum. Conclusion The ideal model would be that cataract surgeons and industry would all lean in at the same time and commit further to adopt and advance this technology. This would provide the maximum benefit to our patients and our profession in the long run. When LACS emerged, we were faced with a new tipping point and what felt like almost the same decision. We were grateful we had been given a second chance in our practice lifetime to make a better decision with technology adop- tion. This time we chose to get involved early. Consequently, I have been able to offer the benefits of LACS to many more of my patients than if I had waited. We also received significant marketing, financial, and reputational advantages in our community, where we have been rewarded for our time and investment in improving the lives of our patients. Examining the impact When choosing to implement new tech- nology, it is important for surgeons to look at the tipping point for their clinics. Before we began offering LACS, I sat down with my staff and shared the docu- mentation demonstrating its advantages. At the end of that discussion, we were a different organization because we were all on board. In addition, we must consider the tipping point of patient adoption. Patients may be hesitant to pay the additional cost. At first, I only told my patients that I preferred to use laser technology, and approximately 10–25% chose this option. When the lasers improved to the point where I could tell patients that the laser was more precise and I preferred to use it, they were less intimidated by the fee. Approximately half chose the femtosecond procedure. Timing of LACS adoption has sweeping implications I n the 2014 ASCRS Clinical Sur- vey, 92% of respondents reported that they will become involved in laser-assisted cataract surgery (LACS) within the next 10 years. We all play a role in determining when this tipping point will occur. Each surgeon's decision to adopt LACS affects his or her partners and colleagues—but also the entire community of ophthal- mologists. Learning from experience When 15-Hz and 30-Hz femtosecond lasers were introduced for LASIK, we pre- ferred to continue using the mechanical microkeratome. We told our patients that it provided superior or equal results. When the 60-Hz laser later made its debut, we held our ground. We adopted a defensive strategy in justifying our choice to patients, even though the fem- tosecond laser was being used for most cases within the profession. We ultimately adopted the femtosec- ond laser about the time the IFS system (Abbott Medical Optics, Abbott Park, Ill.) was introduced. However, it was so late in the adoption pattern that we could not raise our prices to cover our extra time, risk, or technology investment. Although the financial outlay was lower because used machines were available, we lost significant reputation with our referral sources and patients. In contrast, early adopters—and their patients—reaped the benefits. These clinicians gained significant marketing, reputational, and financial advantages. 7 Dr. Foster is a cataract and laser eye surgeon in Fort Collins, Colo. by Gary J.L. Foster, MD Tipping point for femto • You • Your staff • Your partners • Your community • Your colleagues Tipping point principles • Timing • When to jump in? • What you do affects everything around you • Commitment What happens if you pull back? • To you • To all your colleagues • To your patients

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