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acetate four times a day. This eliminates the need for most patients to use topical corticosteroid drops while putting the physician back in control of the medi- cation delivery.”


Lindstrom cites another exam-


ple: a punctal plug delivery system. “The plug is placed in the lower lid by the surgeon at the end of surgery. It releases dexamethasone over about a month’s time. We eliminate the bottles of antibiotic and steroid drops.” Mitchell says some of her sur- geons are increasingly relying upon this “dropless” approach to cataract surgery. “They prefer postoperative injections over drops because they are much cheaper—some of these drops can cost a few hundred dollars per bot- tle—and they eliminate the need for patients to purchase medications and then remember to administer them.” For surgeons who want to continue using drops, Mitchell says there are still ways to improve the patient experience. “We have a surgeon who uses Pred- Gati-Brom combination drop therapy— a single drop for patients to administer that typically costs less than $100. That is a huge savings for our patients, which is helpful since many of them are living on tight, fixed budgets.”


Surgical Improvements


Bilateral, same-day sequential cataract surgery—in which patients undergo surgery on both eyes during a single visit—might soon push out staggering cataract surgery as the standard prac- tice, Lindstrom says. “Cataract procedures have become safe and effective enough where sur- geons are comfortable doing both eyes in the same day,” Lindstrom says. “Surgeons want to do this and patients want it as well.” Unfortunately, Lindstrom says, one significant barrier stands in the way of more ophthalmologists performing this approach to cataract surgery: the Medicare reimbursement penalty on the facility and surgeon if a surgeon


performs cataract surgery on both eyes on the same day. “The good news is that Medicare is considering eliminat- ing or at least reducing the penalty.” At Blake Woods Medical Park


Surgery Center, surgeons are taking another approach to cataract surgery to better meet the needs of patients. “Our surgeons are performing cus- tomized cataract surgery that matches lenses to an individual’s lifestyle,” Mitchell says.


The process includes a screen- ing to determine a patient’s activities and the time spent on them. Activi- ties are broken down by three “buck- ets” assigned to the distance associ- ated with the activities. The bucket for activities beyond 20 feet includes driv- ing, golf and walking. The bucket for activities beyond 30 inches includes using a computer, desk work and hob- bies like crafts. The bucket for activi- ties within 30 inches includes reading and crocheting.


Lenses are selected based upon the typical amount of time a patient spends in each bucket. Patients may receive the same type of lens in both eyes if most activities are spent in a single bucket, Mitchell says. If time is more


significantly split between buckets, surgeons may recommend a “mix and match” of different lenses.


New Technology and Equipment Manufacturers of ophthalmology tech- nology and equipment are providing ophthalmologists with tools that are significantly improving eye surgery, Donnenfeld says. Perhaps most note- worthy is the Zepto cataract capsulot- omy system. “The femtosecond laser allows us to create a near-perfect cap- sulotomy,” he says. The Zepto goes one step further. It provides an automated capsulotomy that is reproducible, fast and delivers great tensile strength. We can place the capsulotomy in the visual axis, improving refractive results.” Diagnostics is another area seeing significant new technology and equip- ment developments, Donnenfeld says. “We can now perform terrific preop- erative measurements of patients’ cor- neas and biometry to achieve better IOL calculations.” That information, which is captured preoperatively in the doctor’s office using optical biometers, can be seamlessly visualized through the operating microscope with intraop- erative measuring devices.


ASC FOCUS AUGUST 2019| ascfocus.org 13


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