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The Essentials of Efficient Cataract Surgery
Look for time savings on the margins to keep pace in this high-volume specialty.
Ophthalmic surgeon Jason J. Jones, MD, performs up to 24 cataract cases a day at the Jones Eye Clinic in Sioux City, Iowa. He is able to keep up the rapid pace during those busy days while also maintaining a constant focus on high-quality patient care. Here are his three keys for moving patients through your facility quickly and safely:
Stretcher chairs. These mobile units allow patients to remain on a single surface throughout the course of their care, a factor that adds to their comfort and protects staff from risks associated with lateral transfers. A single staff member can maneuver motorized stretcher chairs throughout a facility, allowing more staff resources to be allocated to direct patient care.
Models that allow preprogramming of five preset positions contribute to greater clinical efficiencies because staff can adjust the surface with the push of a button to quickly reposition patients at each stage of care. Dr. Jones says vital signs monitors that attach to stretcher chairs remain connected to patients from pre-op to PACU, eliminating the need for staff to remove and reattach the leads in the OR and recovery area.
Standardized safety checks. Establish a well-considered process that allows surgeons and staff to quickly confirm the correct procedure is being performed on the correct patient's correct eye with the correct IOL implant. Questions that arise about any element of a planned procedure should necessitate a hard stop until the issues are resolved, no matter how much the pause slows down the day of surgery.
To ensure patients receive the correct IOL, Dr. Jones created a "microscope sheet," which he fills out several days before scheduled procedures. It contains pertinent information related to the case, including the patient's name, age, hometown, referring physician, astigmatism values, targeted post-op refraction and the chosen implant. On the day of surgery, Dr. Jones tapes the sheet to the surgical microscope and uses it as a quick reference to confirm the details of the case before beginning the procedure.
Prepping in pre-op. Preparing patients for surgery outside of the OR saves time and improves patient flow, says Dr. Jones. In pre-op, his patients receive dilating and antibiotic drops, and nurses place a drop of lidocaine jelly in the eye and wipe it across the periocular skin tissue area several times with a cotton-tipped applicator.
When time permits, Dr. Jones likes to wet a 4x4 gauze pad with diluted povidone-iodine, fold it into a quarter size, place it over the patient's closed eyelid and leave it in place for at least five minutes. The prepping solution dries on the periocular area to provide a longer contact time and an additional layer of protection against post-op infection.
"Efficiency permeates every aspect of cataract surgery, from how quickly procedures are performed to how much patients are satisfied with the surgical experience," says Dr. Jones. "You have to work smarter, not harder, to achieve excellent outcomes."
Pre-op Planning Software for Cataracts Pays Off
Researchers found massive increases in clinical efficiencies, but less certainty about improved outcomes.
A recent study comparing traditional paper documentation and electronic scans with online software methods for preoperative planning of cataract surgeries found that comprehensive software solutions offer a significant reduction in the time required to complete pre-op calculations and manual transcription of data points. The researchers claim this finding has important implications for the efficiency and likely the safety of surgical planning.
The study, published in Clinical Ophthalmology, observed the time required and the number of data points manually transcribed between the two methods in 40 patients to explore whether differences in surgical accuracy could be identified when placing intraocular lens (IOL) implants.
"Recent technological advances in cataract surgery have provided patients with ever-improving visual outcomes with fewer complications, yet the methods used by surgeons for managing the information needed for surgical planning have changed very little over the same time period," note the authors.
During the study, preoperative planning was performed twice for each patient: once traditionally and once with software. Mean total surgical planning time was 239 ± 190 seconds for the traditional method versus 63 ± 31 seconds with the cloud-based software. Mean number of data points transcribed was 7.2 ± 7.2 for the traditional method vs 0.9 ± 1.7 with the software. No statistically significant differences were noted in terms of accuracy of prediction of the spherical equivalent surgical outcome.
"Connected online software offers an avenue that is potentially more free of human error and more time-efficient than current, manual methods of planning," write the authors. "In bypassing the need for online calculators and manual transcription of data, the use of the online planning system used in this study reduced the time required for surgical planning by an average of 88% per eye for post-refractive cases and 60% per eye for non-post refractive causes."
They say the online software is supportive of improving the use of physician resources given the projected growth of cataract surgery, as fewer surgeons could handle more patients with theoretically higher-quality care.
The researchers note that the study did not demonstrate a difference in the refractive accuracy of surgical planning by either method tested. "One would expect that if a significant number of transcription errors occurred in either arm, a difference would be found in the recommended lens implant power," they write. "If such transcription errors occurred, they did not appear to affect the final refractive outcome because both tested methods showed identical refractive accuracy."
The authors say further study is warranted for systems designed to reduce the variability of surgery while reducing the effort of surgical practices to achieve the refractive desires of patients.
This Compact Plug-and-Play Camera System Offers Flexibility and High Performance
Innovative patient care and cost efficiency is this ophthalmologist's goal in his laser and imaging technology choices.
Laser-assisted in situ keratomileusis refractive eye surgery, otherwise known as LASIK surgery, was pioneered in the late 1980s and is now a commonly used procedure to correct farsighted or nearsighted vision deficiencies. The laser and optical systems first used for eye surgery have greatly evolved due to intelligent software, which has resulted in major advancements in laser and imaging technologies. With these capabilities, ophthalmologists are able to make precise corrections during ocular surgery to ensure the best possible outcomes for their patients.
The evolution of laser and imaging devices, and the techniques used to perform advanced eye surgeries, continue to evolve. At the forefront of this medical procedure is Canada's Sorgini Eye Institute located in Greater Sudbury in Northern Ontario. The clinic's Medical Director, Dr. Curtis J. Sorgini, not only follows the latest advancements in laser and imaging technology, but he also takes a hands-on approach in implementing any new techniques, equipment and procedures.
According to Sorgini, when he started performing laser eye surgery in 1995, there was no real equipment standard across the industry. The doctor wanted a way to keep his assistant visually aware of the status of the surgical procedure while he performed it. To accomplish this, Sorgini purchased a standard definition Panasonic camera and an adapter for the excimer laser. He then interfaced the two devices, which allowed the surgery to be visible on a monitor in the operating room.
A few years later, The Sorgini Eye Institute purchased a Leica microscope when the facility opened its own operating room. This microscope had a beam splitter that allowed Sorgini to mount a Panasonic camera directly on it, so he could use a monitor to assist during ocular procedures. It also allowed staff members and spectators to watch a procedure in real time.
4K Performance for Less
"Even though this was still just a standard definition camera, it turned out to be a huge thing," said Sorgini. "We used this setup for a few years, and every time I would go to the American Academy meetings, I would look at these new HD cameras and say, oh man, these look great but they cost 10 to 20 thousand bucks or more, and we can't really afford that. And then I came across the Panasonic i-PRO Sensing Solutions booth at the American Academy meeting. They were displaying a small two-piece camera with 4K resolution that looked great, and it was at a price point that was far less than what I had been looking at from other manufacturers, so I bought one."
The Panasonic i-PRO 4K camera that Sorgini purchased was the GP-UH532 4K 3MOS Ultra HD Micro Camera with 1600TVL resolution. The two-piece camera system includes the GP-UH532HA camera head along with the CCU Unit GP-UH532CA. One of the smallest compact camera heads on the market, the GP-UH532HA features a 1/3-inch image sensor and employs a user interface designed for easy control of the system through an operation menu or a rotating knob. Six or more personal profiles can be stored on a USB memory, and these configurations can be switched to suit a variety of applications.
The camera system features antibacterial coating and complies with IEC 60601-1 (basic safety and essential performance of medical electrical equipment) and IEC 60601-1-2 (electromagnetic compatibility requirements for medical devices) in the U.S. This camera also allows the doctor to simultaneously display images on two monitors in the operating room, so all spectators have an unobstructed view of the procedure.
"Although the Panasonic i-PRO Sensing Solutions sales staff was always available and supportive, I didn't really need their assistance installing the new 4K camera system. Once I found the converter, I just needed to physically mount the camera to the microscope, and then it was all pretty much plug-and-play as far I was concerned," said Sorgini.
About Panasonic i-PRO Sensing Solutions
Panasonic i-PRO Sensing Solutions Co., Ltd., is a global leader of advanced sensing technologies in the fields of Intelligent Surveillance, Public Safety and Industrial/Medical Imaging. Established in 2019, i-PRO was built on a legacy of over 60 years of innovation with Panasonic. The company's products, software and services extend human senses to capture moments of truth with innovations that inform and protect. In order to help create a safer world, Panasonic i-PRO Sensing Solutions Co., Ltd., supports the work of professionals who protect and save lives. For more information visit i-PRO.com.
Cataract Surgery Reduces Dementia Risk
Study shows evidence that improved sensory input could be beneficial to patients.
New research found that patients who underwent cataract surgery had a nearly 30% lower risk of developing dementia compared with individuals who did not undergo the procedure.
The results, published in JAMA Internal Medicine, emerged from the longitudinal data of more than 3,000 participants in The Adult Changes in Thought (ACT) study, a longstanding, Seattle-based observational study at Kaiser Permanente Washington of more than 5,000 participants older than 65.
The processes by which cataract surgery and lessened dementia risk are associated were undetermined in the study, however. Researchers hypothesize that patients may gain higher-quality sensory input after cataract surgery, which might have a beneficial effect in reducing dementia risk.
Lead researcher Cecilia Lee, MD, MS, an associate professor and Klorfine Family Endowed Chair in ophthalmology at the University of Washington School of Medicine, believes that after cataract surgery, patients' retina cells receive more blue light. "Some cells are associated with cognition and regulate sleep cycles, and these cells respond well to blue light," she says. "Cataracts specifically block blue light, and cataract surgery could reactivate those cells."
Dr. Lee is energized by the results. "This kind of evidence is as good as it gets in epidemiology," she says. "This is really exciting because no other medical intervention has shown such a strong association with lessening dementia risk in older individuals." The study results emphasize a strong case for further research on the eye-brain connection in dementia.
Music Calms Patients Before Cataract Surgery
The simple pre-op intervention leads to less stress and a decreased need for anesthesia.
The soothing sounds of music reduce anxiety levels, blood pressure and the need for sedation in patients undergoing cataract surgery, according to recent research.
The study, published in JAMA Ophthalmology, consisted of two evenly divided arms of 310 total cataract patients with a mean age of 68.9 years. The experimental arm received an app-based music listening intervention via headphones, while patients in the control arm wore noise-cancelling headphones with no music playing. Both cohorts used the headphones for 20 minutes before surgery.
Patients who listened to music were less anxious, according to the study, which notes a significant difference in incidences of hypertension in the music group (13.6%) and non-music group (52.9%). The difference in the mean number of sedative drug injections required during surgery was also notable: 0.04 for the music group versus 0.54 for the non-music group.
By reducing hypertension, levels of anxiety and the need for sedative drugs during the procedure, the researchers say, a 20-minute music intervention before cataract surgery appears to offer an effective treatment for anxiety and highlights the importance of listening to music to decrease its debilitating effects. They add that the positive effects of app-based music, which is easily accessible and distributable to patients, has the potential to be used as a large-scale treatment for anxious patients, possibly in the context of other surgeries.