Eyeworld

EW CATARACT 26 June 2015 Role of ophthalmologist in the future Dr. Hoffman thinks there will be a shortage of ophthalmologists in the next 20 years and that adding optometrists to ophthalmic practices is the way forward into the future. "I believe ODs will be used more and more in ophthalmic practices to perform vision exams and post- operative care of surgical patients," he said. "I see an integrated system with ODs working under the supervision of ophthalmologists." Where surgery will take place Both Dr. MacDonald and Dr. Hoffman agreed that a shift to the ambulatory surgery center (ASC) setting for cataract surgery could be beneficial. "I believe that cataract surgery will continue to be moved into ASC settings and completely out of hos- pitals," Dr. MacDonald said. "It will remain in ASCs to allow physicians to cost share and maximize invest- ments, and maintain quality and efficiency." "I believe it is more efficient and cost effective for cataract surgery to be performed in an ASC," Dr. Hoffman said. "The current reim- bursement is much lower in an ASC than the hospital, which should encourage the government to try to shift patients from hospitals to ASCs." However, there are still many cataract surgeries performed in the hospital setting. "I believe that reimbursement should be increased for [surgery done in the] ASC since it can be done more efficiently there, and these ASCs should be rewarded for the increased efficiency and the lower infections and complications," he said. Biggest surprise in the field of cataract surgery Looking back at the field of cataract surgery, Dr. MacDonald said the biggest surprise is the click fees that are being associated with different technologies. "It surprised me that as a community we would accept this, further reducing our ability to be successful business people," she said. Dr. Hoffman is surprised at advancements in the field. "It always amazes me how quickly the field of ophthalmology and in particular cataract surgery has advanced," he said. This includes the transitions from intracaps to extracaps to phaco and now femtosecond laser cataract surgery. "IOL technology has also had a major impact on the success and appreciation of cataract surgery," he said. "I see continued advancement and improvement in all aspects as long as the additional costs can be covered by government reimburse- ment or [the] patient." When proper reimbursement no longer covers the costs of new technology and innovation, innova- tion and advances will slow or stop, Dr. Hoffman said, but he remains optimistic for the future. EW Editors' note: Drs. Hoffman and MacDonald have no financial interests related to their comments. Contact information Hoffman: rshoffman@finemd.com MacDonald: Susan.M.MacDonald@lahey.org required to use preoperative or postoperative drops." Doing this will be a major cost savings for patients and is especially relevant today because generic med- ications have reached prices that are similar to branded medications, he said. The future continued from page 24 K1-5696 (17mm blades) K1-5697 (13mm blades) K3-2440 pointed K3-2442 blunted Double-X Speculums Incision Spatulas Nucleus Splitters Eric Donnenfeld, MD of Rockville Centre, NY Tarek Badawy, MD of Cairo, Egypt K3-2448 for use in the right hand K3-2449 for use in the left hand patent pending Ralph Chu, MD of Bloomington, MN 973-989-1600 • 800-225-1195 • www.katena.com ® This speculum combines arms that open in a parallel fashion with flattened, vaulted blades for the reduction of external pressure on the globe. This significantly aids in docking the laser to the eye. K3-2460 Instrumentation Two versions of this 0.3mm wide incision opening spatula are available. One has a pointed tip (K3-2440) for surgeons who occasionally find incisions challenging to find and open, while the other (K3-2442) has a blunt tip for entering these incisions. This double ended instrument features the blunted 0.3mm incision spatula on one end and a 2mm wide blunt, keratome-shape spatula for opening the main incision on the other. The ultra thin tips on these splitters are designed to fit into the laser created grooves in the nucleus to safely fragment down to the posterior plate. One instrument can be used in conjunction with the phaco tip or two through opposing incisions in a bimanual technique.

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