Moving the location of a surgical practice is a big transition for most surgeons, especially when thinking outside of the box of what is considered “normal”. It is both exciting and challenging to work through. Lance Kugler, MD shares his experience on his transition to in-office cataract surgery, his initial concerns and why he chose to move forward.

Prior to 2016, Dr. Kugler took his cataract patients to an ASC across town. While the ASC had excellent equipment and a good patient experience, he knew it would never be quite as good as the experience of his Lasik patients in the office. That is what led him towards the alternative of in-office cataract surgery. Like many surgeons considering this transition, he had initial concerns regarding safety, staff training and anesthesia.

Safety
It is a common misperception that in-office surgery is done in a clean room or a procedure room. Office-based cataract surgery is done in a full OR. It has the same safety standards, protocols, and sterility as you would find at an ASC. What is different is the terminology around it, how it is credentialed and how the processes are documented. Once Dr. Kugler realized that his office-based cataract suite would be a real OR, his safety concerns were mostly ameliorated.

Dr. Kugler took the time to research the published data on in-office surgery suites and found that there was more published data regarding safety for office-based suites than there was for ASCs. A retrospective study conducted at Kaiser Permanente of 21,501 cataract surgeries found office-based cataract surgery efficacy and safety outcomes to be consistently excellent as those performed in ASCs. In over 5,000 procedures performed in iOR facilities, the safety profile is consistently as good as those in the study. (iOR data involves patients of a younger population than those in the Kaiser study.)

Staff Training
Dr. Kugler had concerns about how he was going to train his existing staff to do something that was completely new to them. His staff that had never done intraocular surgery before going through iOR Partners’ surgical training program. iOR’s surgical experts work with staff members who are identified for specific surgical roles and train them until they are deemed competent. Dr. Kugler was thrilled that we were able to train them to be the best OR team that he has ever worked with.

Anesthesia
Prior to having an office-based surgery suite, Dr. Kugler was used to having an anesthesiologist or a nurse anesthetist onsite to provide IV sedation for cataract surgery. The idea of doing this procedure without IV sedation was a new concept to him. He became more comfortable with the idea after talking to other surgeons who had been doing it for a while and tried it himself at his ASC. He soon realized that not only was the sedation adequate with oral or sublingual, but it was patient preferred. He found that his patients were more relaxed and did not feel like a hospital patient. Now, Dr. Kugler prefers oral sedation and finds it to be a safer and more comfortable way to perform cataract surgery.

Setting up an in-office cataract surgery suite to the highest safety standards is a big undertaking. It requires expertise to do it right. It is critical to have a deep understanding of the space requirements, surgical equipment, staff training, accreditation, the entire billing process and how to set up efficient processes. Dr. Kugler chose to work with iOR Partners because of our laser-focused expertise in office-based cataract surgery. As the only company dedicated to ophthalmic office-based surgery, we work with practices to achieve seamless integration of clinic and surgery in just a few short weeks with no surgery downtime.

Learn more about iOR Partners office-based surgery suites:
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