Clinical Pearls for Upgrading Your Refractive Practice

ByRoger F. Steinert, MD

Currently, many options exist for ophthalmic surgeons who perform refractive surgery. Thus, surgeons who wish to establish themselves as leaders in the refractive surgery market must keep abreast of new technological developments. CustomCornea with the LADARVision System (Alcon Laboratories, Inc., Fort Worth, Texas) is an example of a higher level of refractive technology that is now available to surgeons and patients.

Several steps are involved in upgrading a refractive surgery practice. First, the surgeon must understand the most advanced technology that is available. Second, he or she must be able to communicate to staff and patients how the technology works and what outcomes can be expected. Finally, surgeons must brand their capabilities in the marketplace.

Roger F. Steinert, MD [photo] Roger F. Steinert, MD, is professor of ophthalmology at the University of California in Irvine.

Understanding and communicating new technology

A surgeon must be comfortable with the concepts, vocabulary and the surgical outcomes from a higher standard of technology to effectively communicate these to their patients. Surgeons and patients must understand that CustomCornea is not just new technology but, rather, advanced technology.

Before a surgeon begins to implement external marketing measures, he or she must market new technology internally. Such internal marketing measures may include brochures and posters in the office on CustomCornea technology and educational workshops for staff.

Quality and suboptimal technology do not mix

Staff and patients should be made aware that CustomCornea is not merely an option, but a necessity for better quality of vision. Options can confuse patients, risking overall satisfaction with their experience. CustomCornea provides better quality of vision in terms of contrast sensitivity, higher-order aberrations, uncorrected visual acuity and best-corrected visual acuity. Additionally, CustomCornea also results in fewer refractive surgical enhancements. In my opinion, the quality of vision that is achieved by CustomCornea technology is better than any other refractive surgical option and it is the responsibility of surgeons to make sure that this is relayed to the patient from the moment he or she enters the office.

Figures 1A-C

Integrating CustomCornea into practice

The first consideration when bringing CustomCornea into one’s practice is how the technology will change patient flow. A surgeon should work with clinical staff to establish procedures that will enhance the patients’ experience, such as impleme nting checklists and flags that will move patients along in an orderly manner. Verbal communication must be strong between the staff and the surgeon. It may be helpful to establish a team leader (not the surgeon), who will be responsible for creating a patient-flow system. For example, the surgical staff can take the patient through the clinical intake, pupil capture, registration and dilation procedures, while the surgeon should be responsible for either performing or checking the accuracy of the wavefront capture, flap creation, ablation and postoperative checks.

Once CustomCornea has been integrated into a surgical practice, patient outcomes should be tracked for future reference and comparisons. I urge all surgeons to take a LADARWave (Alcon Laboratories, Inc.) measurement at 1 month postoperatively to facilitate the development of nomogram adjustments to perfect results.

Figures 2A-C

Registration key to better outcomes

The registration system on the LADARVision is the determining factor that makes this technology more reliable and less variable than other platforms. The registration on the LADARWave aberrometer automatically locates the limbus and registers the wavefront map to the limbus, controlling cyclotorsion. Registration is a short process and does not interrupt the patient flow or introduce any amount of inconvenience to the patient.

The easiest way to conceptualize the importance of registration is to think of the wavefront error as a Pringle potato chip (Procter & Gamble). To correct the wavefront error, the excimer laser ablation pattern must precisely match the cornea. Think of stacking Pringles. A large amount of Pringles are contained in a small can because the Pringles all match up and stack perfectly. If the potato chips do not line up, fewer chips fit in the can and the chips can easily be broken. The air space between the poorly matched Pringles can be likened to error in wavefront correction if registration is inaccurate (Figures 1A-1C).

Registration is not only important to treat basic astigmatism, but it is also crucial for correcting aberrations. A unique feature of the LADARVision platform is the ability to take a wavefront measurement, register it to the limbus and achieve a consistent pattern automatically (Figures 2A-2C).

To surgeons who have a reputation in the community of providing superior care to their patients, CustomCornea is a natural fit for their practices.