Office-based surgery is becoming increasingly popular among refractive cataract surgeons. Unlike a hospital or an ambulatory surgery center (ASC) setting, an office-based surgery suite provides the opportunity for more personal control of the entire surgical process, from the protocols put in place to the patient flow to the technology used during surgery.
WHY OFFICE-BASED SURGERY?
I recently visited Aaron Waite, MD, of Waite Vision in Salt Lake City, Utah, to observe him performing cataract surgery in his office. Within a few short hours, I was convinced that office-based surgery had merit and will be the future of cataract surgery. The following are the four main reasons why I believe this to be true.
No. 1: It puts control in the surgeon’s hands. Dr. Waite was in the driver’s seat the whole time. His own personnel scrubbed in for every procedure, and his staff performed the work-ups for patients. All of these elements provide a tremendous safety advantage over surgery in the ASC/hospital setting, and they are all within the clinician’s power to influence. There is nothing more frustrating than being at the mercy of an ASC or a hospital.
No. 2: It enhances the patient experience. It was also plain to see that patients were more relaxed in Dr. Waite’s setup than what I was used to seeing. (At that time, I had only performed cataract surgery in the settings of an ASC and a hospital.) His patients were in a familiar environment, which created a more convenient and comfortable experience for them. On the other hand, ASCs and hospitals can be intimidating environments for patients, not only because they are unfamiliar spaces but also because the ORs are packed with equipment and personnel staff they’ve never met before. It also is not uncommon for patients to have long wait times at an ASC or a hospital, and there is certainly a lack of privacy in both settings.
No. 3: It is safe. The literature suggests that in-office cataract surgery can be done safely, efficiently, and comfortably. In one thorough safety review of 21,501 cataract surgery procedures performed in Kaiser Permanente office-based surgery centers, Ianchulev et al concluded that safety was as good as or better than comparable data from cataract surgery procedures performed in ASCs.1
No. 4: It is cost effective. Another distinct advantage of performing surgery in an office-based setting compared to an ASC or a hospital is the lower cost associated with it. A traditional hospital OR is expensive, largely because of the unnecessary ancillary supplies that are not used during cataract surgery. In contrast, in-office cataract surgery requires just a handful of economical devices that can be selected by the surgeon based on their preferences.
WHY CATARHEX 3?
One of the devices that Dr. Waite uses is the CataRhex 3 (Oertli Instrumente AG, Switzerland), a compact and portable surgical platform for cataract surgery. The device is very powerful and affordable. I had prior experience with this device because my father, John S. Parker, MD, and I used it on various mission trips to third-world countries. He selected the system because it is so compact that it fits in a pilot case and, at the same time, provides the latest technology for phaco-assisted cataract surgery.
When we decided to implement in-office surgery at our practice, Parker Cornea in Birmingham, Alabama, we relied on the familiarity of the CataRhex 3 phaco device to ease us into the transition to performing cataract surgery in an in-office suite, which can be challenging and intimidating to start.
I have been thrilled with the power and the versatility of the CataRhex 3, and our practice uses it for all of our in-office cataract surgery procedures. Its compactness is perfect for the smaller footprint of an in-office surgery suite (figure). Additionally, the device is completely intuitive, and there is zero learning curve. It is also extremely reliable. In fact, the CataRhex 3 is so reliable that we do not even own a backup system, and it requires very little maintenance. This is a huge cost savings to the practice, making it the most economical phaco system available today.
The SPEEP pump of the CataRhex 3 provides more efficiency and precision through its precise control of flow (in 0.1 mL steps) and vacuum. SPEEP combines the advantages of a flow-controlled peristaltic pump with the sportiness of a Venturi pump. With the SPEEP pump, both flow and vacuum can be controlled independently of each other. The SPEEP pump helps me to achieve easier, safer, and more efficient surgeries routinely.
For all of these reasons, the CataRhex 3 is the best phaco platform for office-based cataract surgery.
For years, surgeons have performed refractive surgery procedures in their offices. As cataract surgery continues to become even more of a refractive procedure, it makes sense that these surgeries can also be performed in an office setting. Long-term, I believe more surgeons will take advantage of the benefits of in-office cataract surgery because it is a more economical setting compared to an ASC or hospital.
It’s been a joy for me to perform in-office cataract surgery with the CataRhex 3. I believe the procedure and the easyPhaco technology (Oertli) both make me a better surgeon, and it allows me to perform the procedure in a more comfortable environment for patients. We even broadcast the surgery on Facebook Live for patients’ families who are in the waiting room.
I’ve often asked myself, “When it comes time for me to have cataract surgery, where would I want to go?” I’d prefer a more comfortable and economical setting in an in-office suite, and I believe that our patients do, too.
For those who are interested in starting with office-based surgery, I believe that the CataRhex 3 is the best phaco device to invest in. It is the most economical, reliable, and durable system available today.
1. Ianchulev T, Litoff D, Ellinger D, Stiverson K, Packer M. Office-based cataract surgery: population health outcomes study of more than 21 000 cases in the United States. Ophthalmology. 2016;123(4):723-728.