1. Office-based cataracts. Office-based surgery is likely to become
standard care for routine cataracts and lens replacements, driven
largely by their minimally invasive techniques, the successes of LASIK
suites and the desire to create a better patient experience, says Dr.
Waring. "We'll be looking to our dental and oral surgery colleagues,
who do many things well in terms of patient service," he says, adding
that ophthalmology's trend toward oral sedation and minimal IV seda-
tion "fits into this paradigm nicely." Offices won't be able to accommo-
date general anesthesia, special equipment and the complex cases they
support, but they could make cataract surgery more approachable for
patients, he says.
Medicare doesn't currently reimburse office-based cataracts, but the
agency has reportedly considered the subject. Keep in mind, though,
that even self-pay cases face roadblocks at present. "The fact that it's
technologically feasible, and it is, doesn't mean it's economically feasi-
ble yet," says Steve Sheppard, CPA, COE, managing principal of the
Medical Consulting Group in Springfield, Mo. Renovating, equipping
and staffing a space to meet state-specific requirements and to handle
surgery's demands could take several solidly scheduled years to break
even, he notes. Additionally, physician-owners might not see a financial
incentive to export ASC cases to office suites.
2. Heads-up digital microscopy. Ophthalmic microscopes are
paragons of precision, but they're still using traditional optics and
they're still less than kind to physicians' necks. Digital optics will offer
advances on both fronts, says Daniel S. Durrie, MD, founder of Durrie
Vision in Overland Park, Kans., and a clinical professor of ophthalmol-
ogy at the University of Kansas Medical Center in Kansas City, Mo.
Integrating digital visualization into eye surgery could enable 3D imag-
ing, a view of surgery for everyone in the room and the ergonomic
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