Evaluation of a hub-and-spoke model for the delivery of femtosecond laser-assisted cataract surgery within the context of a large randomised controlled trial
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g.
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests


  • Responses are moderated before posting and publication is at the absolute discretion of BMJ, however they are not peer-reviewed
  • Once published, you will not have the right to remove or edit your response. Removal or editing of responses is at BMJ's absolute discretion
  • If patients could recognise themselves, or anyone else could recognise a patient from your description, please obtain the patient's written consent to publication and send them to the editorial office before submitting your response [Patient consent forms]
  • By submitting this response you are agreeing to our full [Response terms and requirements]
Publication Date - String

Vertical Tabs

Other responses

Jump to comment:

  • Published on:
    We must continue testing delivery models to create more efficient surgical care
    • Cassandra L. Thiel, Assistant Professor NYU School of Medicine
    • Other Contributors:
      • Daniel S. Morris, Ophthalmologist
      • John E. Somner, Ophthalmologist
      • Andrew Cassels-Brown, Ophthalmologist
      • Peter B. M. Thomas, Ophthalmologist

    We were interested to see Roberts, et. al study [1] which explored whether a hub-and-spoke model using a femtosecond laser (FL) could increase the efficiency and reduce the cost of cataract surgery.

    Although the model was not cost-effective when compared to conventional phacoemulsification surgery, more efficient models should continue to be assessed. The Aravind Eye Care system uses an alternative hub-and-spoke model. Instead of separate operating theatres (OTs), the physician alternates between two beds in a single OT. This model, and the safe reuse of surgical supplies, results in phacoemulsification cataract surgery with excellent outcomes at 1/20th the cost and carbon emissions [2-4].

    Roberts, et. al recommend that the ideal number of OTs to maximise the utility of an FL in a hub-and-spoke model is four. However, they were not able to evaluate the effect of adding additional OTs to their model as they only had two OTs. We suggest that adopting the Aravind model to jump to the 1:4 model without further building work could significantly alter this paper’s conclusions. We would be interested to know if elements of the Aravind model, two beds one theatre, could be adopted in their setting.

    On average patients receiving FLACS spent 5.85±1.99 mins in the laser suite (LS), implying a potential throughput of between 8 and 15 cases per hour. We are interested to know the authors views on the the limits of the FL and what impact the adoption of bilateral...

    Show More
    Conflict of Interest:
    None declared.