Surgeons across the country have different ways of explaining how new techniques improve the health of their practices and their patients. Some surgeons focus on efficacy, others on efficiency. Most say the two are mutually inclusive.

Many surgeons cite better economics and better outcomes as two results that good techniques can produce. Some doctors also love to advance technique just for the thrill of providing the most modern patient care possible -- being on the cutting edge, if you will. Here, we've asked two surgeons to share their perspectives on the benefits of incorporating advanced techniques into their operating rooms.

By Larry E. Patterson, M.D., with Vickey Hawkins, C.O.A.

Crossville, Tenn.

When speaking to groups, I often ask, "How many of you have been my cataract surgery patients?" One evening a woman said, "You did my surgery today." She showed few signs of surgery. She wasn't patched, and her eye was just slightly red. She said that her vision was improved already. Some of the audience switched eyecare physicians that evening.

Many patients remember the ordeal of cataract surgery from the experiences of their parents or grandparents. There was the hospital stay; a needle behind the eye, sandbags, no bending and aphakic spectacles.

These people will tell you about their fears. They're skeptical about the advances they're hearing described today. But they needn't be. Here are some improvements I've made in my practice to put my patients at their ease.

• I keep them comfortable.
I routinely use topical anesthesia and operate in the afternoon, so my patients can have breakfast and take their medications. They don't have to change clothes or remove their false teeth. They sit in recliners or lie on stretchers in our holding area discussing cataract surgery with each other. And they watch each other enter and leave the operating room in a matter of minutes.
• I give them the benefit of the newest techniques.
Microsurgical techniques have created some new approaches to cataract surgery. I use a diamond blade to create a self-sealing, 2.8-mm clear corneal incision. For technique, I either chop or flip, depending upon the density of the nucleus. My surgical time rarely exceeds 6 minutes.
I also utilize many refractive options, including limbal relaxing incisions, as well as toric and multifocal intraocular lenses. I use these specialty implants selectively and have had great success.
• I interrupt their normal lives as little as possible.
My patients are on their way home 10 minutes after surgery; their total stay at the surgery center is about 90 minutes. We ask them to take it easy that evening. They're usually able to return to their normal activities the following day.

Many patients go out a couple of days postsurgery wearing solar shields. "The surgery was quick," they say, "For the first time in years I can do things without glasses."

Just one happy patient can share his positive experience with countless other people. This patient is a walking billboard for any doctor. What better form of advertising is there?

By John Wright, D.O.

Colorado Springs, CO.

Many surgeons who try phaco flip quickly give up because of cloudy corneas the first morning post-op.

I quit for almost a year before trying again. Not until I took a course did I begin to understand the nuances. Then I started to achieve clear corneas on the first morning post-op and noticed a dramatic increase in my operating efficiency. This made me think about the benefits of phaco flip and about how to be more efficient.

Three benefits of phaco flip are:

• It causes fewer capsule rupture
s. You work further away from the posterior capsule and so you rupture fewer capsules.
• It helps reduce complications.
Time isn't wasted on extra steps for grooving and cracking the nucleus. The phaco tip is kept in view rather than going behind the iris. Instead of three cases per hour, we can comfortably perform six or seven.
• It's fast but accurate.
If I have 20 cataract procedures to perform on a given day, I can complete them by noon with fewer complications and devote the rest of the day to being productive in other parts of the practice.

Patients love having surgery completed quickly and efficiently. Word-of-mouth referrals increase as they tell their friends. Your operating room manager will like it too. Personnel hours and operating costs decline.

Consider these issues:

• Your office procedures.
Handle charts as few times as possible. Identify refractive targets during the exam instead of getting a stack of charts to check over later. Get the A-scan and paper work done at the same visit.
• Your facilities and staff.
You need two operating rooms. When you're performing surgery in one, your staff can set up in the other.
Your staff must be large enough and share your desire to work efficiently. My practice is at a "wall" of six or seven cases per hour because we lack total control of the support personnel at the ASC we use.
If your staff see no reason to work more quickly or feel that they're already working as fast as they can, you may not be able to be as efficient as you'd like. If you have your own ASC, 10 to 12 cases per hour become possible. You can hire extra staff.
• Avoiding the pitfalls.
These hints will help steer you:
• Learn the clear corneal sutureless techniques.
• Use the ORs for surgery only.
• Review post-op instructions in the discharge area, away from the heavy traffic spots.

Follow this advice to benefit your patients and yourself.