EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/111385
36 EW CATARACT February 2013 Device focus The business side of femto for cataract by Michelle Dalton EyeWorld Contributing Writer Ef���cacy and safety issues aside, practices debating how to integrate a femtosecond laser and when to use it should read on At Hoopes Vision, two different femtosecond lasers reside in a previously underused OR. Source: Robert Rivera, M.D. W hen evaluating whether or not to purchase a femtosecond laser for refractive cataract surgery, the question is not whether or not the technology is viable, but how to bring a very expensive and spaceconsuming piece of equipment into the surgical area without disrupting patient workflow. Leading authorities tell EyeWorld how they went about it. Physical placement Physically smaller practices���those with one or two ORs���that have dedicated refractive and cataract suites have an advantage over a general teaching hospital where the OR is used by various specialties, said Kevin M. Miller, M.D., Kolokotrones Professor of Clinical Ophthalmology, Jules Stein Eye Institute, Los Angeles. Ambulatory surgery centers (ASCs) with three or four rooms, however, have a harder situation ���because you might have two doctors doing cataract surgery on a given day, and you���re probably not going to buy one femto laser for each room,��� Dr. Miller said, adding some bigger facilities are ���just finding a closet where they can place it.��� The dilemma for ASCs is that most haven���t been built with enough physical space to house the laser and may end up placing it on another floor altogether, said Robert P. Rivera, M.D., in private practice, Hoopes Vision, Draper, Utah. His group was already scheduled to move into a new facility at the end of last year, so they reconfigured the space to accommodate the two femtosecond lasers the ASC uses into their own dedicated room. For Robert J. Weinstock, M.D., in private practice, the Eye Institute of West Florida, Largo, there were already four ORs and a good amount of pre-op and post-op space, ���but what we didn���t have is a lot of ���extra procedures��� room. In one small room we have a YAG laser and an argon laser, but no room to house more.��� The group weighed several options, including ���stealing��� a conference room, or taking some space away from the kitchen and other administrative areas. They decided to place the laser in one of the ORs and drop down to three rooms for intraocular surgery. At the Center for Sight, Sarasota, Fla., William Soscia, M.D., said four of the surgeons are cataract specialists, and the entire ASC is ���very high volume.��� The group spent almost two years evaluating how to incorporate the technology into the available space and ultimately opted to build a separate room, complete with an observation area for family to watch while staff members narrate the entire femtosecond aspect of the procedure. Dr. Miller said ���moving 80- and 90-year-olds around is no simple matter,��� but at Jules Stein the only place to put the femto laser was on a different floor from the surgical suite, and that with 10 surgeons continued on page 38