This issue of Ophthalmology Management is all about refractive cataract surgery.
Refractive cataract surgery is a combination of the techniques of refractive surgery and the techniques of cataract surgery. The goal is to achieve a patient’s desired refractive correction following cataract surgery and reduce their dependence on contact lenses and spectacles for best vision.
LOW RISK, HIGH REWARD
Why would cataract surgeons want to be involved in refractive cataract surgery? I look at it as a win-win-win-win situation with little downside.
Patients win because they get better services and access to better implants and devices. Doctors win because they have the ability to make their patients see better and generate a little extra revenue, which is critical in this era of ever-declining reimbursements. Device companies win because they make extra revenue, some of which can be allocated to research and development of new products. And finally, society wins because patients who see well after surgery do not go for endless appointments with their doctors because they are not seeing well, much of which is paid by the government through its taxpayers.
I have had the good fortune of being a member of the American Society of Cataract and Refractive Surgery (ASCRS) for more than 30 years. Recently, I was invited to join the ASCRS executive board. The ASCRS is committed to helping its members thrive in this era of refractive cataract surgery by delivering content that is appropriate to the clinical side of the delivery model, but also understanding and implementing the business side in a fair and compliant manner. Much of the programming that will roll out in the future will be along these lines.
PEARLS FOR ALL EXPERIENCE LEVELS
To assemble this issue of Ophthalmology Management, I tapped three colleagues in the Cataract and Refractive Surgery Division of the Stein Eye Institute at UCLA. In addition, we have contributions from several world-class key opinion leaders who I highly
respect.
Dr. John D. Bartlett starts off the issue by discussing the incredible downward spiral of payments for cataract surgery over the last four decades. The decline in reimbursement coupled with the increase in practice expenses is nothing short of jaw dropping.
Dr. Vance Thompson, incoming president of the ASCRS, talks about how an ophthalmologist can transition from standard cataract surgery to refractive cataract surgery. This is daunting if you have not already done it. You will find that the biggest obstacle is your own mindset, but the mindset of your office staff will not be far behind. A simple step-by-step approach makes it possible, however.
Dr. Shawn R. Lin talks about the astigmatism management model we use at UCLA. It’s a common-sense approach that can be used regardless of the lens that will be implanted. It does not need to be reserved for toric lens cases only.
Dr. Mitra Nejad discusses the use of intraoperative refractive guidance devices to improve spherical and toric refractive outcomes. Ophthalmologists can choose from several such devices on the market.
Dr. Kendall E. Donaldson reviews the use of femtosecond lasers to produce highly accurate and reproducible incisions in the cornea and lens.
Dr. Nicole R. Fram covers everyone’s worst nightmare: the patient who pays extra money expecting a certain refractive outcome but then — for whatever reason — does not achieve it. How do we take the patient from disgruntled to happy? Believe it or not, it is possible most of the time.
Finally, Drs. Eric D. Donnenfeld and Sahas Narain talks about our exciting collective future of cataract surgery: accommodative lenses, preferably whose power can be adjusted continuously for the life of the patient. Given that accommodating lenses are just over the horizon, how do today’s refractive cataract surgeons position themselves to be ready when these new technologies arrive?
I encourage you to challenge yourself and read this issue, whether you are somebody who is sitting on the sidelines or you are a “know it all.” Even if you’re in the latter bucket, you are likely to find a pearl that will cause you to think. If you are sitting on the sidelines, I hope this is the “kick in the butt” that gets you into the refractive cataract arena. OM
