The landscape of cataract surgery has changed rapidly—first with premium intraocular lenses (IOLs) and now additional refractive cataract options such as laser-assisted cataract surgery (LACS) and intraoperative aberrometry. With so many changes in technology, the choices that patients have to make, and the expectations they have for refractive outcomes, optometrists need to know how to counsel patients in this new environment. I think patient counseling is just as important for optometrists who refer patients for cataract surgery as it is for those of us working in surgical practices.
Mann Eye is an integrated OD-MD practice, but we also comanage with several external optometrists. From our perspective, it is critical that patients hear consistent messages about how new technology may be able to benefit them. That is best achieved when referring doctors themselves are well educated about cataract surgery, LACS, and what to expect at our facility.
The ideal comanagement scenario is one in which the patient is happy with his doctor’s knowledge and guidance, happy with the surgical experience, and achieves outstanding visual results. That is a patient who will rave about the results, refer friends and family, and return to the knowledgeable doctor who took such good care of him. Both the surgeon and the optometrist look good—and neither has to deal with extensive chair time.
Integrating LACS in our practice
Once our practice decided to move into the laser cataract space, we carefully evaluated the LACS systems on the market. After practice site visits and seeing assembly plants for several, we ultimately selected the Catalys Femtosecond Laser System (Abbott Medical Optics). My job then was to figure out how to integrate the laser into our clinical flow and how to educate staff, referring clinicians, and patients. As the first practice in the U.S. to acquire this laser, we really had to blaze our own trail.
I created a timeline and a training plan, which we have since used as a template for other new technology acquisitions, including the LipiFlow thermal pulsation system (TearScience) and the ORA intraoperative aberrometer (WaveTec).
The first task, well in advance of acquisition, was to determine how LACS would affect our surgery center. We needed to determine which entity would actually purchase and own the laser, whether any space build-out or HVAC changes would be required, and how we would track and bill for use of the laser. We also had to do some financial modeling to determine our goals and structure our fees.
We decided to install the femtosecond laser in one of two operating rooms (ORs) at our Houston surgery center. Surgeons alternate between the two rooms. With multiple instrument sets and an efficient break-down team, we have been able to keep the patient flow moving quickly so that LACS didn’t slow us down for long.