Eyeworld

60 | EYEWORLD | SPRING 2026 ATARACT C by Liz Hillman Editorial Co-Editor About the physicians Brad Feldman, MD Philadelphia Eye Associates Philadelphia, Pennsylvania Mark Lobanoff, MD OVO LASIK + Lens St. Louis Park, Minnesota Shahzad Mian, MD Chair, Professor Department of Ophthalmology and Visual Sciences University of Michigan Medical School Ann Arbor, Michigan O ral sedation for cataract surgery has been used in some capacity for at least the last 20 years in the U.S. With the recent increase of office- based cataract surgery, which almost exclusively uses oral sedation, and general success seen with what's considered an efficient, cost-saving, and, at times, safer sedation option, discussion has begun on whether oral sedation options could become the primary care model even within ambulatory surgical centers (ASC) or hospital settings where IV sedation is current- ly most common. "This is important because it's a change from the way most cataract surgeons have traditionally done cataract surgery. We're used to IV sedation, and when you're comfortable with something in a surgical setting, it's hard to break out of your rut," said Mark Lobanoff, MD, adding that he had a mild panic attack when he opened his office-based surgery suite, which just uses oral sedation, in addition to a topical or intracameral anesthesia to prevent pain. "I had never done cataract surgery with just oral sedation before. To my pleasant surprise, it works, and for the vast majority of patients, oral sedation is a superior method of sedation to IV." Reasons cited by Dr. Lobanoff include: 1. The patient experience: With oral sedation there are no IV sticks, no need for a sepa- rate doctor visit to ensure physical health for safety of IV sedation, and no need for a 6–10 hour fast prior to surgery. 2. Patient safety: Several studies support the safety of oral sedation in cataract surgery for the right patient. 1–3 "A patient who's calm, relaxed, pain-free but still in control of their cognitive functions, in my opinion, so far has been safer," Dr. Lobanoff said. 3. Efficiency: There are fewer preop logistics with oral sedation and a shorter postop re- covery period. "With IV sedation, they have to be in recovery for a half hour. That slows the whole center down," Dr. Lobanoff said. 4. Cost: IV sedation and all that it entails is a greater cost to the medical system, he said. Dr. Lobanoff is not alone in these opinions. Shahzad Mian, MD, also acknowledged benefits to oral sedation, including the fact that time can be saved in avoiding a pre-anesthesia health assessment. "We use a checklist of questions that helps us determine whether the patient can have the low-risk anesthesia and doesn't have to go through a detailed evaluation, which was a precursor to transitioning over to oral sedation from IV because it is a lower-risk type of anes- thesia for the patient, and therefore we don't need as detailed of an evaluation," he said. There is also the benefit of not being de- pendent on availability of an anesthesiologist or certified registered nurse anesthetist (CRNA). "There's a shortage of anesthesiologists and CRNAs. 4 There's not adequate coverage avail- able for performing procedures," Dr. Mian said. Brad Feldman, MD, said he operates 50% of the time in an office-based surgical suite with oral sedation and the other 50% of the time in an ASC. When in the ASC, 99% of the time, he's using IV sedation with an anesthesiologist or CRNA monitoring. The other 1% of the time, he's using oral sedation for reasons like the pa- tient forgetting to skip breakfast that day, inabil- ity to get IV access, or other reasons where oral sedation is simply deemed safer by the surgical team. "It's gotten us out of trouble where we would have had to cancel cases," Dr. Feldman said. "And the patients have all done well." Dr. Feldman said there doesn't seem to be anything negative about the use of oral sedation in the right patient. "From a patient perspec- tive, it's easier, more comfortable, there are less hoops they have to jump through. They don't need to see a primary doctor to be cleared Will oral sedation become mainstream? continued on page 62 A photo taken in Dr. Feldman's office-based surgery suite. Many office-based surgery suites exclusively use oral sedation for cataract surgery. Source: Philadelphia Eye Associates

• Cover