They said 2020 would be the year of the ophthalmologist. I think we can all agree this year has not quite started as planned.

From cancellation of elective surgery to frantic reading of federal rescue packages and social distancing, our lives have been shaken by COVID-19. Even this edition of Ophthalmology Management was impacted — the original plan was for a special ASCRS issue focused on cataract and refractive surgery. With COVID-19 on the forefront of everyone’s mind, we changed the content in some aspects while wishing to keep the edition relevant as well.

So as we see fewer patients, we find ourselves thinking more — trying to plan what the future will hold for our practices, our field and our world. At the same time, we wish to stay on top of the cutting-edge technology and techniques that make us love this field so much. With this issue, we hope to balance both, much as we all try to find balance in our own lives.

IMPACT ON OUR PRACTICES

Cancellations of elective surgeries basically shut down ophthalmic practices and ASCs. The recommendation to defer nonessential exams to follow social distancing further compounds the freeze on revenue. The impact is dramatic regardless of the type of practice. Quentin Allen, MD, discusses the effect of the virus on practices across the country and how the financial impact is different from previous recessions (page 12).

We review tips on how to implement telemedicine in ophthalmology both during the pandemic as well as beyond. The rules and regulations for billing, however, are complex. Brandy Sperry and Kevin Corcoran break it down with an excellent review of billing telemedicine in the era of COVID-19 (page 16). This may spark a new way to practice ophthalmology and provide care for patients even after we are out of the pandemic.

BALANCING QUALITY WITH REIMBURSEMENT

There is no doubt we will see a resurgence of cataract surgery. Considering the number of cases and evaluations that have been postponed, we will have a rebound once elective surgeries can proceed. Yet with the decreasing reimbursement, will this really help the bottom line for practices? Will premium lens surgery still be in demand if baby boomers’ retirement plans are cut in half? How much overhead can we really cut from each surgery? On page 24, we review the changes in cataract reimbursement and offer suggestions for optimizing revenue.

We also want to maintain the excellent outcomes from cataract surgery despite the pressure to do more surgery in the future. A triad of fantastic surgeons in Naveen Rao, MD, Daniel Anderson, MD, and Michael Patterson, MD, review their technique of choice when there is no capsular support (page 28). Kourtney Houser, MD, addresses postop inflammation and offers some alternatives to just standard generic eyedrops (page 34), and Sam Garg, MD, and Paul Israelsen, MD, PGY-4, review preoperative strategies in the evaluation to optimize outcomes (page 38).

THE FUTURE

The future is unknown for ophthalmology, the health system and for the world we live in. We don’t know what our new normal will be even after the pandemic levels. However, one thing remains: our strength. It is truly inspiring to see people come together despite the challenges. Here in the Texas Medical Center, I see the joint effort to fight this virus from multiple academic centers and hospitals that are normally in competition.

In ophthalmology, we see sharing of ideas on list serves and social media, virtual happy hours to connect with colleagues and peers, and adapting to the new normal we live in. It is truly inspiring to be part of the field that, even apart (at least 6 feet!), strives to stay together. OM

Sumitra S. Khandelwal, MD, is an associate professor of Ophthalmology at Baylor College of Medicine in Houston, Texas and serves as the medical director of the Lions Eye Bank of Texas.