BLOG: Consider shifting preop testing to surgery center
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The workflow for cataract surgery at our private ophthalmic ASC in Newport Beach, California, has been continually evolving with the advent of new technology.
Several years ago, we incorporated a fixed-bed femtosecond laser in a dedicated laser room that feeds several operating rooms. To make this work efficiently, we cross-trained the ASC nursing staff to also work as certified laser technicians. The nurses are assisted by expeditors who manage the patient and the bed while the RN manages the laser. Total surgeon time in the laser room is less than 2 to 3 minutes per case.
More recently, following an upgrade to new software for the Catalys femtosecond laser (Johnson & Johnson Vision), our ASC nurses are now performing testing that we have typically considered clinic-based preoperative testing. That’s because the latest iteration of the Catalys integrates with the Cassini Ambient corneal diagnostic device (Cassini Technologies). It uses the Cassini total corneal astigmatism data to identify and mark the steep axis for toric IOLs and to plan arcuate incisions for management of smaller amounts of astigmatism. This eliminates errors related to manual marking and transcription of data, and it considerably reduces the time the surgeon needs to spend planning, calculating and running data through online nomograms. I love the efficiency and precision that is possible when these two devices are linked together.
All of this can be done with a Cassini device located in one’s office and the data transferred via USB drive to the surgery center. However, there are good reasons to consider placing the diagnostic device at the ASC. With multiple Catalys users at the ASC, not all of whom have a Cassini in the office, this setup allows everyone to take advantage of the integrated data and planning capabilities. Additionally, I’ve been impressed by the quality of the Cassini imaging and measurements that we get on the day of surgery. By that point, patients have been using preoperative drops for several days or weeks already and their tear film has been optimized, so we can be confident that Cassini’s total corneal astigmatism is the best possible measurement to use for the automated Catalys planning. Of course, I still compare the biometry and the astigmatism correction plan to my preoperative biometry measurements from the clinic before confirming the planned axis and incisions.
A downside to having the Cassini at the ASC is that surgery center staff are less familiar with preoperative measurement devices. There is a learning curve as they adapt to using a joystick and learn the nuances of capturing the best images. However, staff who are experienced in the laser room and the OR quickly realize the value of the Cassini capture when I show them how we use the images and data throughout the case to match iris features, align preoperative and intraoperative axes, and position the IOL.
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