BLOG: An open letter to phaco companies
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Dear phaco companies (I’m talking about you, Alcon, Bausch + Lomb, Johnson & Johnson Surgical Vision and Zeiss),
I’d like to have an honest conversation with you about where we are going with cataract surgery, at least in the U.S. There are some important trends my colleague and I are considering, and it might be worthwhile for you to know about how we feel.
It’s been several years since there has been significant innovation in phaco machines, and your newest generations, which regulate fluid inflow based on actual fluid being removed, are most impressive. You’ve somehow even figured out a way to account for fluid leakage through wounds, which means we can have a stable anterior segment with minimal post-occlusion surge and relatively low pressure in the front of the eye. That means less forceful infusion of fluid, less volume of balanced salt solution running through the eye, less corneal edema, and even less stress on the zonules and macula. It probably also keeps small fragments of lens material from moving into the vitreous. In young myopic patients, it means less lens-iris diaphragm retropulsion syndrome — that painful, sudden deepening of the anterior chamber when infusion is turned on. This is a meaningful improvement in our current technology, and it definitely prompts us to look at replacing our phaco machines with new ones when the time is right.
Please also consider how to make your fancy new machines and their supplies fit the place where I hope to work in the next few years. We are thinking about moving our surgery into the office. Like many of my colleagues, my practice has an ASC. We are fond of working there right now and have an extremely safe and comfortable environment for our patients. But we realize hundreds of our colleagues have already shown that office-based surgery can be equally safe. Right now, we would lose money if we moved surgery into the office, but we know CMS is already moving toward an alternate payment model that will present a financial incentive for this change. We’re wary of moving from IV to oral or no sedation, but with a little coaching, we’re pretty sure we can make that change. Maybe most importantly of all, we understand that surgery in the office is probably much more comfortable for patients. Yes, there are a number of barriers to adopting office-based surgery. Please help us remove one of those barriers by making your machinery and all its supplies rightsized for the office.
My staff and I are concerned about the amount of material we throw away after surgery. Sustainability is increasingly important, especially to our young associates. Throwing away a large plastic cassette with its packaging is unappealing. Only one of you — Johnson & Johnson Surgical Vision with its Compact Intuitiv machine — currently offers a phaco machine in the U.S. that has reusable, resterilizable tubing. We are starting to use it with great results, and we’re telling other surgeons about it. We realize you make more money when you sell us single-use cassettes, but if you listen to your customer, you’ll figure out a way to preserve profits while giving us the resterilizable tubing we want.
Finally, I sincerely want to thank you for your incredible engineers who give us better and better tools with every generation of machine. Who go to work every day to help people they will never meet. Who make us heroes for our patients. We know the competing priorities I’ve presented here are tough to reconcile, but we’re pretty sure you’re smart enough to figure this out. By helping each other, we can both do well by doing good.
Follow @DrHovanesian on X, formerly known as Twitter, and Instagram.
For more information:
John A. Hovanesian, MD, FACS, an ophthalmologist specializing in cataract, refractive and corneal surgery at Harvard Eye Associates in Laguna Hills, California, can be reached at drhovanesian@harvardeye.com.
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