EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/111385
38 EW CATARACT February 2013 The business continued from page 36 vying to use the laser, ���it���s going to be a total nightmare.��� Impacting the work���ow The Catalys (OptiMedica, Sunnyvale, Calif.) is the only one of the devices where patients can have the femto portion done on the same bed as their cataract removal, Dr. Rivera said. From a patient perspective, that���s the least disruptive, he said, but not all machines are capable of that just yet. ���Ergonomically, we had to decide what would make the most sense,��� Dr. Rivera said. ���The downside to that scenario is that it does commit that room to only the surgeons who are going to use the Catalys. That only works in a situation with dedicated anterior segment surgeons.��� E\ E\ &XUYHGFDSVXORUKH[LV IRUFHSVF\VWRWRPHWHHWK ��WVWKURXJKPPLQFLVLRQ The same great performance for less performance +LJKTXDOLW\UHXVDEOHRSKWKDOPLFVXUJLFDOLQVWUXPHQWV +LJKTXDOLW\UHXVDEOHRSKWKDOPLFVXUJLFDOLQVWUXPHQWV 6XUJLFDOVWDLQOHVVVWHHOWLSVDQGGXUDEOHKDQGOHVPDGH 6XUJLFDOVWDLQOHVVVWHHOWLSVDQGGXUDEOHKDQGOHVPDGH RIDFRPSRVLWHSRO\PHU RIDFRPSRVLWHSRO\PHU 3HUIRUPDQFHHTXLYDOHQWWRWKHEHVWFRQYHQWLRQDODOO 3HU IRUPDQFHHTXLYDOHQWWRWKHEHVWFRQYHQWLRQDODOO PHWDOLQVWUXPHQWV PHWDOLQVWUXPHQWV 6LJQL��FDQWO\ORZHUSULFHGWKDQDOOPHWDOLQVWUXPHQWV 6LJQL��FDQWO\ORZHUSULFHGWKDQDOOPHWDOLQVWUXPHQWV (OLPLQDWHWLPHDQGH[SHQVHRIGHDOLQJZLWKPLVDOLJQHG (OLPLQDWHWLPHDQGH[SHQVHRIGHDOLQJZLWKPLVDOLJQHG EHQWGDPDJHGRUORVWLQVWUXPHQWV EHQWGDPDJHGRUORVWLQVWUXPHQWV 0RULD,QF����PRULD#PRULDXVDFRP��ZZZPRULDVXUJLFDOFRP The logistics of scheduling several surgeons when the femto resides alongside a phaco machine is daunting, Dr. Miller said, but it���s equally difficult when the femto is in a separate location. ���It���s now going to take a procedure that takes, say, 20-25 minutes in an average person���s hands, or 10 minutes for somebody who���s really fast, and make it at least twice as long, if not three times as long, if the laser is outside the room,��� Dr. Miller said. With reimbursement rates declining, losing time on one patient because of logistics can be economically devastating. Workflow can be difficult in very high volume practices, Dr. Soscia said. ���Before we had the LensAR [Orlando, Fla.] in our practice, we analyzed how to incorporate it���we started focus groups from patients to gauge interest, we evaluated where to physically place it, we looked at staffing issues, and then we tackled how we were going to market this to our patient base.��� Dr. Weinstock���s group, ���a relatively high-efficiency, high-volume center, where we like to do somewhere between seven to eight cases per hour at least,��� realized positioning the femto in its own room ���would improve the efficiency of patient flow and keep the surgeon from being idle.��� With almost 50% of their patients undergoing limbal relaxing incisions, toric lenses, or premium IOLs, the center has turned one OR into an advanced cataract room complete with intraoperative aberrometry and 3D guidance software. The patients move directly into this room after their femtosecond laser treatment in another room. There is also a standard OR for traditional cataract surgery. ���We made the decision to take one of our remaining two ORs and put both the LenSx [Alcon, Fort Worth, Texas] and the Catalyst in there,��� Dr. Rivera said. Sharing responsibilities Surgical centers will need to evaluate not only patient workflow, but also surgeon workflow. Dr. Soscia said in the previous three months, he���s probably performed ���over 600 femtosecond cases.��� He volunteered to be the ASC���s femto expert and has reorganized his schedule so that three days a week he���s doing femto for his partners, and one day a week he���s doing the femto for his own patients. ���With this setup, I can do about eight laser cases an hour, therefore allowing the cataract surgeons to perform the same number of cases as they were prior to the femtosecond laser,��� Dr. Soscia said. Dr. Miller will likely have each surgeon do his or her own femto cases initially, ���and then we���ll have to figure out what makes the most sense. We���ll have a technician be the femto laser technician just like we have in our laser practice center. It may even be the same person.��� Eventually, he predicts fellows will do part of the procedure. Dr. Weinstock split the responsibilities with his partners���one day they each do only the femto, the next they do only the cataract surgery aspects. Dr. Rivera has not transitioned into this model yet, but his new facility will allow them to do so. ���If I have 20 patients scheduled for cataract surgery on an afternoon, at least 50% of those are getting femto,��� Dr. Weinstock said. ���So that���s the equivalent of doing 30 procedures, not 20. [You have to] take into account bringing the patient into the room, programming the laser, getting the patient in position, doing the procedure, and on and on. This takes just as long as the cataract surgery itself. So far, it���s working great to divide the tasks with two surgeons. We can each keep our focus. And if you���re the guy who���s just doing lasers, you���re 100% focused on just doing the laser.��� For the other surgeons? ���They���ve got 50% of the procedure already done,��� Dr. Soscia said. ���Me? I���m just in the zone.��� EW Editors��� note: Drs. Miller, Rivera, and Soscia have no financial interests related to this article. Dr. Weinstock has financial interests with Alcon and Bausch + Lomb (Rochester, N.Y.). Contact information Miller: 310-206-9951, kmiller@ucla.edu Rivera: 801-568-0200, rpriveramd@aol.com Soscia: 941-806-9784, sosh@tampabay.rr.com Weinstock: 727-244-1958, rjweinstock@yahoo.com