Eyeworld

131 Supported by unrestricted educational grants from Alcon Laboratories and Bausch + Lomb by Elizabeth Yeu, MD Building a premium technology practice Y oung surgeons will find that building a cataract practice based on ad- vanced technology and a premium patient experi- ence can be professionally and fi- nancially satisfying (Figure 1). But it can also be daunting to know where to start and how to incorporate new technologies in a smart way. The first step doesn't cost a penny: Com- mit to achieving the best possible refractive outcomes. With that as a guiding principle, start implanting toric IOLs as a first step, add presby- opia-correcting IOLs, then explore the value of making major capital equipment investments. Start with torics Of all the premium technologies, toric IOLs are the low-hanging fruit. Astigmats, with their lifelong depen- dence on vision correction, can be among your happiest patients. There are a lot of them (about one-third of patients have >1.0 D of corneal astigmatism), and the technology to satisfy their distance vision needs is excellent. Initially, focus on easier cases, including those with: regular, stable astigmatism; moderate astigmatism (1.0–3.0 D); average axial length (22.0–25.5 mm); good zonular and capsular support; and a healthy cor- nea and retina. Clinically, you have to have ex- cellent technique, an understanding of your surgically induced astigma- tism (sia-calculator.com), and pay close attention to the ocular surface to ensure that your measurements are accurate. Also, utilize diagnostic tools that you trust to confirm the axis and amount of astigmatism. Presbyopia- correcting IOLs Contemporary presbyopia- correcting IOLs can deliver on the promise of spectacle indepen- dence. To offer them successfully, you have to believe in the value of spectacle independence for patients' lifestyles. When patients are paying out of pocket, make sure they enjoy a pre- mium experience in your practice. An enthusiastic and educated team is key, and I found that I need to schedule differently so that my staff and I can "stay in the zone" with cataract consults instead of rush- ing through them. Consolidating my cataract evaluations to one day helped me grow my refractive cat- aract surgery conversion rate from about 35% in 2013 to 55% in 2014. Offering financing and incorporat- ing a team of concierge staffers to greet and escort patients can also be beneficial. Capital equipment investments The more advanced technology IOLs you perform, the more you will real- ize that other technologies, such as advanced topography/tomography, surgical guidance/intraoperative aberrometry systems, and lasers, can contribute to improving results. Your biggest debate will likely be whether and when to acquire a fem- tosecond laser for cataract surgery. It's a big-ticket investment, but one that can also make a big difference in outcomes and word-of-mouth referrals. For our practice, it helped to grow the share of premium pro- cedures, tripled our non-insurance- based cataract revenue, and signifi- cantly increased overall cataract surgery volume (Figure 2). Success builds on itself. Ulti- mately, a larger advanced technolo- gy IOL case volume will provide the confidence and the revenue neces- sary to support further technology acquisition to continue to improve outcomes and differentiate your practice. Dr. Yeu is assistant professor of ophthalmology at Eastern Virginia Medical School and in private practice at Virginia Eye Consultants (VEC), Norfolk, Va. She can be contacted at 757-622-2200 or eyeu@vec2020.com. Figure 1: In 2014, refractive cataract surgery with femtosecond laser and/or a premium IOL contributed more than $3 million in additional practice revenue. Figure 2: With the acquisition of a femtosecond laser, overall cataract volume increased due to increased referrals. Femtosecond laser helped grow cataract surgery volume overall Total cataract procedures (All VEC surgeons) 4000 3000 2000 1000 0 2011 (Before FS laser) 2012 (FS Year 1) 2014 (FS Year 3) 7.7% increase 33.2% increase Standard phaco/ standard IOL Toric/ presbyopia IOL LACS/ monofocal Premium revenue LACS with toric/presbyopia IOL $2,013,955 LACS/monofocal $1,156,375 Standard phaco/standard IOL $0 2014 VEC premium procedure revenue 60% 19% 21% Elizabeth Yeu, MD

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