Offering ICL surgery in an office-based setting will benefit your practice and your patients
By Parag A. Majmudar, MD, and Neel S. Vaidya, MD, MPH
The concept of office-based surgery (OBS) in ophthalmology is not new, but it does represent a shift from a traditional approach of performing surgery in either a hospital or ambulatory surgery center (ASC). Many practices, ours included, feel that the OBS model helps create a premium patient experience that can be leveraged to promote elective procedures such as implantable collamer lens (ICL) surgery. Because we can control the patient journey from the first point of contact through their surgical experience and follow-up care, patients perceive our level of service as not only efficient but also first-class.
Increased consumer demand, advancements in technology, and the introduction of novel procedures have led to growth in the refractive surgery market over the past few decades. According to Market Scope, the global refractive surgery industry will generate about $12 billion in total revenue in 2027 compared with $8.9 billion in 2022, accounting for a compound growth rate of 6.2%. The biggest drivers of growth, according to the report, are lens-based refractive surgery and lenticular extraction. Market Scope also expects refractive lens exchange and phakic IOLs to outpace laser-based procedures in the next few years, with the driving forces being advancements in lens technologies and increased adoption of phakic IOLs.1
Many of us have performed laser vision correction procedures in our offices for years without considering it to be OBS. Now, the trend toward performing lens-based procedures in the office setting is pushing us to reconsider how we align the goals of both types of surgeries, placing an emphasis on patient-centered care and focusing on streamlining efficiency. Patients pay for their outcomes, but they tell their family and friends about their experience.
One strategy to capitalize on the growth potential of refractive surgery is to offer ICL surgery with the EVO ICL™ (STAAR Surgical) in the OBS setting. The synergies between the EVO ICL and OBS are myriad. Elective and premium procedures that have a cash-pay component, like ICL surgery, are the perfect segue to offering OBS and are a natural extension of the ophthalmic surgical procedures that can safely be performed in the office to provide the highest quality of customer service.
Performing OBS can provide significant tangible and intangible benefits to both patients and the practice. Provided an OBS suite is built with the highest standards comparable to an ASC, patients should feel comfortable knowing that their outcomes will be consistent with those achieved in other surgical settings. Additionally, patients receive greater continuity of care, are familiar and comfortable with the environment, and have already established a comfort level with the practice staff. As a result, they feel more comfortable checking in on surgery day than they may at a hospital or ASC.
Additionally, in an era where staff shortages and decreased OR time are true concerns in ASCs and hospitals, OBS can ensure that the practice’s elective surgical volume does not decrease. There is a financial incentive for surgeons to perform surgery in an OBS suite, but the most valuable advantage, in our opinion, is being able to provide the highest quality surgical care, safety and outcomes, and patient customer service in our own office.
State and federal regulatory compliance and reimbursement challenges can dissuade surgeons from considering an OBS model, but ongoing advancements in the regulatory framework and reimbursement policies help poise OBS in an increasingly prominent role in the delivery of high-quality, patient-centered care.
Streamlining Surgery to Enhance the Patient Experience
Compared with a hospital or ASC, the OBS setting offers surgeons and staff more control of the patient journey. When ICL surgery is performed in our OBS suite, we know exactly which staff members will greet patients when they walk in the door, give them their drops and sedation, scrub in on the case, and check patients out after the postoperative examination. Because of this, we continually fine-tune the process. Additionally, the preoperative workup is customized to the procedure being performed. Patients undergoing ICL surgery only complete the workup required for the procedure rather than jumping through all the administrative hurdles that are often required in a hospital or ASC. This tailored experience breeds higher ICL acceptance rates in our practice.
We have also found that an OBS model reduces the time between patient consultation and surgery. One reason for this is that patients appreciate the opportunity to have their procedure scheduled at a time that may be more convenient to them, rather than being limited to the dwindling surgical block at a given center. This is important when offering a premium elective procedure such as ICL surgery.
Controlling patient anxiety is also an important part of the transition to OBS. Paradoxically, patients may have more anxiety in a hospital or ASC because of certain logistical hurdles, such as traveling to an unknown location and completing an unfamiliar registration process with staff members with whom they have not previously interacted. Patients are often anxious on surgery day regardless of the location, and therefore anesthesia is a crucial component of patient care. In an OBS setting, oral anxiolytics are often substituted for intravenous sedation. We have found that generally healthy patients are less anxious, less disinhibited, and easier to manage on oral sedation.
Lastly, streamlining the surgical procedure involves careful selection of OR staff. It is important to have an OBS manager who is responsible for the scheduling and maintenance of inventory, including ordering and cataloging ICL lenses. Our OBS manager is also a highly experienced surgical scrub technician, and we have circulators to accompany patients from check-in to check-out. This creates a high level of customer service, enhancing the experience for ICL patients.
Patient Selection
There is a learning curve with OBS. One tip is to select routine cases and patients without difficult personality traits or anxious tendencies to reduce the time it takes to get comfortable performing surgery in this setting. Another tip is to start by performing 20 to 30 cases in an ASC with patients under oral anesthesia only. This can help surgeons build confidence that they can deliver the same results regardless of the environment in which surgery is performed.
With the ICL procedure, there is not much variance in technique between cases. For this reason, it is a great procedure to begin your OBS journey.
Another helpful tip is to involve your coordinators in the patient selection process. They are attuned to patient needs and personality traits because they engage with them on a day-to-day basis and answer a lot of their questions. This kind of background information is helpful because we may not be able to glean the same insights in the few minutes we spend with patients.
Like other patients who undergo surgery in an OBS suite, ICL patients should be counseled that the procedure is often well-tolerated with minimal sedation needed. Most patients are concerned about pain both during and after surgery. Before surgery begins, a staff member should ensure patients are positioned as comfortably as possible while allowing ergonomic flexibility for the operating surgeon. Although an ophthalmic drape is necessary to ensure sterility, it can often feel claustrophobic to patients. In our OBS, a flexible arm is placed under the drape to elevate it above the patient’s face. Oxygen flows through the arm to improve patient comfort throughout the procedure.
In our view, the use of OBS in ophthalmology will continue to become more mainstream. An elective and premium procedure like ICL surgery is a great first procedure to offer in a well-designed OBS facility.
Reference
- Market Scope: lens-based procedures will push retail refractive surgery market to $12 billion. Eyewire. January 10, 2023. Accessed March 10, 2024. https://eyewire.news/news/market-scope-lens-based-procedures-will-push-retail-refractive-surgery-market-to-12-billion
Parag A. Majmudar, MD, is an Associate Professor of Ophthalmology at Rush University Medical Center in Chicago and President and Chief Medical Officer of Chicago Cornea Consultants in Highland Park, Illinois. He can be reached at pam
