Eyeworld

MARCH 2021 | EYEWORLD | 41 C by Liz Hillman Editorial Co-Director About the physicians Rosa Braga-Mele, MD Professor of Ophthalmology University of Toronto Toronto, Canada David F. Chang, MD Clinical Professor University of California, San Francisco San Francisco, California Huck Holz, MD Kaiser Permanente Santa Clara, California exposure to the staff, to the OR, to the clinic, to even a family member who will be sitting in the car with them," he explained. Iqbal "Ike" Ahmed, MD, Warren Hill, MD, and Steve Arshinoff, MD, wrote an editorial in Ophthalmology calling ISBCS "the one change in practice that could have the most significant benefit in reducing infection exposure risk." 1 Dr. Holz said he thinks ISBCS could help ophthalmologists get through what he called "unprecedented backlogs." "These backlogs are most easily addressed with efficiency. Doing bilateral cataract cases from a healthcare perspective is advantageous because you can take one small room and it's almost like turnover time between surgeries is half. You're reprepping, redraping, regowning, regloving, everything is completely turned over, but your facility is much more productive and you can do more cases and can get more surgi- cal bang for your buck and serve more people this way," he said. Barriers to ISBCS In terms of barriers to adopting to ISBCS, the physicians cited safety and reimbursement as the most common impediments to adoption. Bilateral endophthalmitis and TASS are con- cerns with ISBCS. Dr. Braga-Mele said if one follows various safety guidelines set forth by the International Society of Bilateral Cataract Surgeons (iSBCS), she doesn't think ISBCS has any further risk than delayed sequential bilater- al cataract surgery. The iSBCS, which as of January 2020 moved its documents to the Eye Foundation of Canada, put forth principles in 2009 for safe ISBCS. They include informed consent and patient choice, aseptic separation of the two procedures (different instruments, lot numbers for drugs and supplies, intracameral antibiotics, etc.), actions to avoid IOL power errors, defer- ring the second eye if any problem occurs with the first that cannot be immediately resolved, and more. 2 Dr. Braga-Mele said she follows the principles set forth by the iSBCS and uses intracameral moxifloxacin in a dilution T he temporary shutdown of elec- tive surgery in the U.S. due to the COVID-19 pandemic left ophthalmol- ogy among the hardest hit specialties and created a sizable backlog of proce- dures, especially cataract surgery. When oph- thalmologists returned to the OR, their numbers were reduced to limit patient and staff exposure to ongoing community spread of the virus. With that, some ophthalmologists have been considering immediately sequential bi- lateral cataract surgery (ISBCS) with renewed interest to help get through a backlog of cases efficiently and to ease patient anxiety about coming in for surgical procedures. Rosa Braga-Mele, MD, is one of these ophthalmologists. "I never did [ISBCS] before the pandemic. I didn't have a reason to, unless it was someone who came from far away or if I had to put someone under [general anesthesia]. … I usually spaced my eyes a week apart, main- ly for refractive reasons but also for reimburse- ment reasons," Dr. Braga-Mele said. Reducing exposure, plugging through backlogs After the more than 3-month shutdown, Dr. Braga-Mele said she returned to the OR initially at 50% capacity, then 80%, and now is back to 100%. Since returning, she's started looking at ISBCS as a way to keep surgical numbers up while keeping the actual number of patients coming in lower than usual, thereby helping to minimize COVID exposure risks. Huck Holz, MD, who operates at Kaiser Permanente, which has a payment model that doesn't financially affect the decision of same- day vs. delayed cataract surgery, said Kaiser has seen a 6.5% increase in ISBCS system wide during the pandemic. This, he said, is mostly patient driven. "Patients simply do not want to come in twice," Dr. Holz said. With COVID-19, many thought leaders and patients are seeing ISBCS as a way forward, Dr. Holz said, noting that ISBCS is offered at Kaiser by ophthalmologists who are comfortable per- forming it for patients who are good candidates. "It cuts their exposure in half. … They have less exposure to the pharmacy. They have less Will the pandemic push ISBCS acceptance? continued on page 42

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