Ophthalmology practices have been facing many challenges in recent years, including staff shortages, rising wages and decreasing reimbursement. However, we have also seen several innovations and advancements over the same period that allow us to alleviate some of these challenges. Surgeons now have many options and tools at our disposal that improve patient care and efficiency.

As a reflection of this, my cataract offerings and workflow have changed tremendously in the last 5 years alone, most notably in the realm of the cataract evaluation.

CIRCA 2018

When I walked into an exam room just 5 years ago, I would do so with a paper printout of IOL calculations that listed IOL options, few of which were premium IOLs. Along with monofocals, we had one extended depth of focus lens and a few multifocal IOLs, all of which were diffractive. Once we decided on an IOL, I’d circle it on the sheet and write down any other data or imaging requests for my staff to obtain. I relied on staff to prepare these charts and calculations for IOLs manually, and sometimes we would need to run additional formulas, such as LRI or post-refractive calculations.

In addition, our informed consent and patient education processes were discussion based with an informative handout, which routinely led to lengthy discussions and chair time. Furthermore, while I listed all of the risks, benefits and alternatives, my delivery might be different between patients.

I also found myself staying late after clinic to finish IOL selection and surgical charts for the next OR day. I had to perform any additional data or calculations by myself, because everyone else was gone for the day.

FAST FORWARD TO TODAY

In only 5 short years, we have seen a digital and IOL revolution. The biggest change has taken place in surgical planning and integration with our microscope. In our OR, we utilize technology such as Zeiss’ Veracity Surgical Planner, which is integrated directly into the our surgical microscopes with Callisto (Zeiss) for digital marking. We also leverage Alcon’s Argos, ORA and Verion Image Guidance System. Nowadays, I walk into the exam room with Veracity on an iPad, which comes loaded with nearly all the calculations I need to plan my surgeries. I can show patients their astigmatism, view and share their imaging and select an IOL with an optimized constant based on post-operative data running through latest generation formulas. Then, the plan is seamlessly delivered to my surgical microscope, so I don’t have to print anything.

All of my cataract patients watch and have access to supplemental digital content that I have created, such as informed consent videos in which I review the risks, benefits and alternatives to cataract surgery as well as what to expect, advanced technology lenses and other relative information. This has significantly improved my patient’s understanding of the surgery and the process while reducing the number of patient questions, thus leading to increased exam room efficiency.

As for the IOLs, we have seen an explosion over the last few years with new offerings such as Vivity and PanOptix (Alcon), the Light Adjustable Lens (RxSight), Tecnis Synergy and Symfony OptiBlue (J&J Vision), ClearView 3 (Lenstec) and more that have provided so many options for patients who may not have been candidates for previous premium lens technology.

In addition, my ability to treat glaucoma patients has expanded with the evolution of minimally invasive glaucoma surgery (MIGS). Five years ago, I hardly performed any MIGS. Now, I’ve used nearly every MIGS device on the market — all of which have significantly contributed to helping my patients manage their glaucoma.

BENEFITS FOR ALL

The modern cataract surgeon has many available tools, including advanced biometry, surgical planning software, digital microscope markers, femtosecond lasers, next-generation surgery systems, cutting-edge IOLs and virtual consults.

Along with increasing efficiency and patient outcomes, adopting these technologies may also help offset decreasing reimbursement rates by increasing efficiency and providing additional revenue streams through the offering of premium services. OM

J. MORGAN MICHELETTI, MD, FACS, is a board-certified cataract, refractive and complex anterior segment surgeon. He was named to the Best Cataract Surgeons in America list, recognized as Castle Connolly Top Doctor and was named to Ophthalmology Management’s 40 Under 40 in 2022. Email him at morgan.micheletti@gmail.com. Relevant disclosures: Dr. Micheletti revealed relationships with Alcon, Glaukos, J&J Vision, New World Medical, RxSight and Zeiss.