OphthalmicASC Aug

AUG 2017

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R E T I N A | OASC O nce considered too technically challenging and time- consuming to perform in an outpatient setting, retina sur- gery is making its way into the ASC setting. What is the impetus behind this change? In a word: technology. "Advances in surgical retina in the last decade have been nothing short of phenomenal," says Pravin U. Dugel, MD, managing partner of Retinal Consultants of Arizona and a founding member of Spectra Eye Institute, a multispecialty ophthalmic ASC in Sun City, AZ. "When I was in training, patients required general anesthesia and an overnight stay in the hos- pital. Surgeries could take several hours, and outcomes weren't nearly as good as they are today. Now, our surgeries are faster and more efficient. We use local anesthesia and smaller gauge instruments. Sutures are rarely necessary, and recovery times are faster." It's no wonder that ASC owners who are interested in growing their busi- nesses often ask Dr. Dugel if now is a good time to include retina in their ASCs. "That is a relevant question, but the answer is complex," Dr. Dugel says. "Our surgeries are not only faster but also technologically more intense. The extent of training, skill, and technical proficiency that a retina surgeon needs is far greater today than a few years ago. In addition to a technically proficient surgeon who achieves consistently good outcomes, an ASC needs a surgeon who is aligned with its goals of delivering efficient, cost-effective care." ASC owners thinking about adding retina to their surgery centers also must be aware of the significant investment required for good instrumentation. "Equipping an OR for retina — vitrectomy system, laser, gases, cryotherapy, handheld instruments — can cost upwards of $1 million per room," Dr. Dugel says. "In a proper setting, you would have redundancy for all of that equipment to ensure appropriate patient care even if a machine breaks during surgery, which has happened to all of us. It's a huge investment." If you're ready to equip your new retina OR or if you anticipate upgrading some equipment in your existing OR, here are insights on some of the newer technologies and a peek at what's to come. Advances in Vitrectomy Systems The vitrectomy system could be considered a cornerstone of the retina OR. Some recent advances in cutting technology, fluidics, and lighting have enhanced safety and efficiency. The Ultravit 10k probe (Alcon), which is used with the Constellation Vision System (Alcon), has a beveled tip and delivers 10,000 cuts per minute (cpm) via dual pneumatic drive technology in 23, 25+, and 27+ gauges. "These days, surgeons are using vitrectomy cutters as multifunctional tools, 7 T H E O P H T H A L M I C A S C | A U G U S T 2 0 1 7

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