By outward appearances, Omni Eye Services in Atlanta, GA, and Island Eye Surgicenter in Long Island, NY, couldn’t look more different. Omni Eye is a 5,000-square-foot ASC that sees approximately 5,000 cases each year, consisting mostly of cataract, glaucoma, and corneal procedures, with 12 full-time staff and two CRNAs.
Island Eye, on the other hand, sees approximately 15,000 procedures a year, the bulk (10,000) of which are cataract cases, with retina, oculoplastic, and glaucoma procedures rounding out the caseload.
Yet, the two centers share one important characteristic: They represent a growing number of ASCs taking an integrated approach to outfitting their surgical suites with technology from a single manufacturer to reduce costs, streamline procedures, and improve patient outcomes.
Why Choose Integrated?
“We chose the integrated system, first and foremost, to improve patient outcomes, and secondly, to improve patient flow and the time spent on each patient,” explains Island Eye’s Eric Donnenfeld, MD, a partner at the ASC, which utilizes the Zeiss Cataract Suite. The suite comprises the Callisto Eye OR Management System and the OPMI Lumera 700 microscope, along with the IOL Master 500 and IOL Master 700 biometry system (see “Zeiss Cataract Suite,” page 22).
“I chose an integrated system primarily because of the seamless way in which these technologies communicate with each other, maximizing the capabilities of each component,” says Lawrence Woodard, MD, medical director of Omni Eye Services, which leverages all five components of Alcon’s Cataract Refractive Suite. These consist of: the LenSx Laser; the Verion Image-Guided System; the LuxOR LX3 Ophthalmic Microscope; the Centurion Vision System; and the ORA System with VerifEye+ Technology (See “Alcon Cataract Refractive Suite,” page 22). An “informal sixth component” of this suite are the AcrySof advanced intraocular lenses.
Another advocate of the integrated system approach is John Davidson, MD, who operates two dedicated ASCs in California: Lynn Eye Surgery Center in Thousand Oaks and Westlake Eye Surgery Center in Westlake Village. Dr. Davidson runs the Centurion Vision System, LenSx Laser, and ORA System with VerifEye+ Technology (all Alcon products) at both locations.
“I like the advantages of a fully integrated system: compatibility, consistent user interface across devices, and upgrades that further integrate rather than risk increasing incompatibilities,” explains Dr. Davidson. “One company’s idea of an upgrade could render incompatible a previously harmonious piece of equipment by another company.
“We track our 1-month post-op manifest refractions using the ORA’s AnalyzOR website and have been thrilled to achieve results within 0.5 diopters of target in 85-95% of eyes, depending on lens model and [whether the patient has had] prior refractive surgery,” he adds.
Thinking Ahead
All three ophthalmologists agree that having an integrated system is the preferred approach when making capital purchases for today’s highly computerized ASCs.
“Some features of each component wouldn’t be utilized fully if the technologies couldn’t completely communicate with each other,” explains Dr. Woodard.
“For instance, the Verion interfaces with the LenSx laser, Centurion, and LX3 [microscope], allowing me to navigate through each step of cataract surgery without any manual marking of the eye, which decreases the chances for human error in data transfer during preoperative planning and surgery,” he says. “With the components working together as intended, I am able to improve efficiency.”
Indeed, Dr. Woodard described in detail how the components work individually and in concert to improve each step of the surgical process to a degree not achievable as recently as 10 years ago.
“I love that Centurion allows me to move through the various steps of Verion by using the wireless foot pedal. I love that Verion gives me a digital overlay in my microscope so that I can visualize the intended axis of placement of a toric IOL, center a multifocal lens, and appropriately size and center a manual capsulotomy,” he says, adding that Verion permits him to establish a preoperative plan and electronically transfer data to the LenSx laser, which then electronically executes the plan.
“Regarding the LX3, I enjoy having the ability to directly record my surgical procedure along with all the metrics from the Centurion machine, as well as the video overlay information from Verion and ORA,” Dr. Woodard says. “Because I’m able to visualize the preoperative steep axis and the measured intraoperative steep axis, I feel these two technologies help me more accurately measure and treat patients who need astigmatism correction with a toric IOL or corneal-relaxing incisions.”
When Mixing and Matching Components Can Work
The integrated systems approach may not work in every circumstance. Indeed, there may be times when “mixing and matching” may be a better approach to outfitting your ASC’s surgical suites.
“The mix-and-match approach may work for some ASCs because they may have a better relationship with some companies than others, which may lead to financial savings if some of the components are purchased from those entities,” says Lawrence Woodard, medical director of Omni Eye Services, an ASC in Atlanta.
“It may also be beneficial because most companies don’t offer all the components for a surgical suite, so the ability to pick and choose based on availability would offer more flexibility when new technology arrives,” Dr. Woodard adds. “Therefore, [if an issue arises] in the future with some of the equipment — or that company were to have financial difficulties — one would not be permanently married to one manufacturer.”
He cautions, however, that not all technologies from different companies work well together, likely resulting in gaps in functionality and efficiency.
“For instance, Alcon’s Verion will work with other manufacturers’ microscopes, but not with other femtosecond laser machines or phaco machines,” he says. “Therefore, to maintain full capability of some technologies, one must have some components that are from the same manufacturer.”
Error-reduction and Future-proofing
Another advantage is that ASCs used by multiple surgeons can reduce the risk of surgical errors by employing the integrated system approach, says Dr. Donnenfeld.
“An ASC that has multiple surgeons would benefit from an integrated system, because there is a uniform approach that can be easily taught to the staff and ophthalmologists,” he says.
Another reason to employ a suite of technologies? To help future-proof an ASC against obsolescence.
“Technologies change with time,” Dr. Woodard explains. “These components will continue to communicate together as upgrades become available and as additional components are added to the portfolio over time.”
Alcon Cataract Refractive Suite
- The LenSx Laser
FDA cleared for anterior capsulotomies, corneal incisions, and phacofragmentation for cataract surgeries, this laser features a variable numerical aperture for optimized corneal and lens cuts; enables the patient to remain on gurney from pre-op through post-op; and has a hydrogel interface that completely fixates the eye. - The Verion Image-Guided System
This system images and measures the undilated eye, then sends the captured data into a software program that can be used to plan each step of the surgical procedure. The file can be transferred wirelessly via the cloud to the LenSx Laser to auto-align with the predetermined plan. - The LuxOR LX3 Ophthalmic Microscope
This microscope features an expanded illumination field with a large, highly stable red reflex zone, greater red reflex stability during patient eye movement and other intraoperative maneuvers, and increased depth of focus for crisp visualization of multiple planes of the eye at once. - Centurion Vision System
The Centurion is a phacoemulsification system that monitors and adjusts to conditions in the eye during surgery to ensure that the patient’s intraocular pressure remains stable. - ORA System with VerifEye+ Technology
ORA is a guidance and verification system that uses wavefront aberrometry data in the measurement and analysis of the refractive power of the eye (i.e. sphere, cylinder, and axis measurements) to support cataract surgical procedures.*
*The next generation of the ORA System will be introduced this year.
Zeiss Cataract Suite
- Callisto Eye OR Management System
Callisto Eye is an OR management system that integrates seamlessly with OPMI Lumera 700, superimposing the assistance functions of the system in the eyepiece via IDIS (Integrated Data Injection System). Callisto Eye can be controlled from the microscope’s foot control panel or handgrips. Control can be simplified by the easy-to-use graphical user interface on the big touch screen. Multiple mounting options allow seamless integration into any workplace in the OR. - OPMI Lumera 700 Microscope
Intended for both anterior and posterior segment surgeries, the OPMI Lumera 700 features Stereo Coaxial Illumination (SCI) for a brilliant red reflex, fully integrated HD video recording, and Superlux Eye xenon illumination for whiter, more natural light, and automated functions designed to save time. - IOLMaster 500 or 700
The IOLMaster 500 or 700 optical biometry devices help surgeons select the right IOL for each patient with a system designed to be reliable, straightforward, and easy to use. The IOLMaster 700, the latest version, incorporates swept-source OCT technology and the latest Barrett formulas, which the company says can result in a “powerful combination to reduce the risk of refractive surprises.”
System Shopping: Key Considerations
When shopping for an integrated system, do your due diligence, including visiting other ASCs that use the technology you’re considering for your own surgery center, says Dr. Davidson.
“If you like what you see, have a demo in your OR. The integrated systems should be intuitive to use, provide proven results, and have a plan for hardware and/or software updates,” he says.
While cost should be a consideration, keep your primary focus on the quality of patient care and the quality of the technology in your ASC, says Dr. Donnenfeld.
“My best advice is to stay with one system that integrates at a high level to provide optimal patient results,” he says. “Cost is always a factor, but quality is more important.
“The ASC is a partnership between technology and the surgeons who use it,” concludes Dr. Donnenfeld. “Having best-in-class technology is the most important reason that a surgeon chooses to use a specific surgery center.” ■
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