Eyeworld

44 | EYEWORLD | FALL 2026 ATARACT C He speculated that as private equity purchases more into ASCs, combining ORs for efficiency purposes and combined systems that allow both anterior and posterior system surgery will become more common. Discussing features of combined machines more specifically, Dr. Weng said the fluidics and cut rate of these machines not only im- pact surgeon efficiency but also patient safety. "Minimizing the 'hassle factor' is critical for both the surgeons and their staff, so the interface has to be user-friendly. The spaces we operate in are crowded with equipment and supplies, so a smaller footprint is quite welcome; this may be increasingly important if office-based surgery gains traction. Finally, having a full portfolio of disposables for facilitating cross-usage is critical. If a surgeon is not able to use their preferred in- strument with a given platform, it will certainly impact the appeal of that platform," she said. Dr. Weng thinks there are clear advantages for a combined phacovitrectomy system, even for cataract surgeons, given the likely need to manage unexpected posterior segment com- plications. "As mentioned earlier, the optimiza- tion of cut rate and fluidics facilitates a safer vitreous cleanup, which may lessen the risk of retinal tears, retinal detachment, cystoid macular edema, and endophthalmitis. Addition- ally, if a retina surgeon becomes involved, they will be able to immediately proceed without having to set up another machine, which can be quite cumbersome, and also perform any other maneuvers necessary such as pars plana lensectomy for retained lens fragments. For the cataract surgeon, this means a quicker turnover for their room and potentially a happier patient who might be spared a subsequent surgery," Dr. Weng said. Dr. Patterson said he thinks a combined machine would be safer for anterior segment procedures simply because the vitrectomy capa- bilities are more powerful with a faster cut rate. "There are some legitimate benefits to that," he said. "Plus, there are some retina surgeons who are doing cataract surgery, and it saves them a lot of time." For cataract surgeons, those who do a lot of sutured lenses or complex cataracts where they deal with vitreous routinely, Dr. Patterson said the combined phacovitrectomy machines could be helpful. "There could be a situation where someone thinks, 'I do a lot of sutured lenses. I when there is vitreous loss, but the cataract surgeon is usually limited in their ability to visu- alize the peripheral retina in these cases. Hence, I would argue that ideal performance thresholds are just as important for an anterior vitrectomy as they are more posteriorly. One of the advan- tages of the newer generation combo machines is that their functionality for anterior vitrectomy is exactly the same as it would be for a dedicat- ed retina platform." Practices and surgery centers considering a combined machine, especially if they don't have retina specialists, need to think about whether getting the more expensive combined version is worth it. From Dr. Mai's perspective, it's likely not. "If there's a retina procedure that needs to be done, there are plenty of other retina doctors around who already have well-established workflows and referral patterns, and they'll probably send them that way instead of getting a machine and having a very occasional use of the posterior segment side," he said. Dr. Weng said that as a retina specialist who performs combined surgery regularly, she hasn't personally observed a major shift toward combined phacovitrectomy systems yet. "I have noticed that even though our ASC has had com- bined phacovitrectomy systems for years, what would happen is that the retina surgeon would want to work on one particular machine and the cataract surgeon—or even the same retina sur- geon performing both the vitrectomy and phaco —would want to work on another machine. It was hard to fault them for these preferences because the combined machines usually had excellent performance in the posterior segment but not the anterior segment, or vice versa." The benefits of a combined machine include the setup process, staffing resources, cost, teardown time, and footprint. These, she added, cannot be understated. "The next-generation combined phacovitrectomy systems not only help reduce all of the aforementioned indirect costs, but their improved performance means that neither surgeon needs to feel like they are compromising on the quality of their equipment. Additionally, a shorter surgical time may be ben- eficial for the patient in general," Dr. Weng said. Michael Patterson, DO, sees a value in combined machines for ASCs that have retina surgeons operating on Tuesday and Thursday and cataract surgeons operating on Monday, Wednesday, and Friday, for example. continued from page 43

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