Archive August 2014 XV, No. 8

Premium Cataract Surgery Finds Its Place

A sizeable number of patients are paying out of pocket for upgrades. But cost is a limiting factor, facility managers say.

Outpatient Surgery Editors


cataract surgery PAYING FOR UPGRADES In the typical facility, from 11% to 20% of all patients purchase at least one service out of pocket.

For close to a decade, patients have been allowed to pay out of pocket for such cataract surgery upgrades as toric and presbyopic IOLs, astigmatism-correcting arcuate incisions, intraoperative wavefront aberrometry and now laser cataract surgery. To find out just how popular and prevalent these out-of-pocket upgrades are, last month we surveyed 212 managers at facilities that host cataract cases.

We found that premium services are becoming a bigger and bigger part of cataract surgery. In the typical facility, from 11% to 20% of all patients purchase at least one service out of pocket. Overall it’s been a positive trend: The outcomes are generally good, patients are generally pleased and the upgrades are providing surgeons (although not facilities) some extra profit.

The main problem: Many elderly cataract patients don’t have the money to pay for upgrades. As a result, facility managers expect only moderate growth in these services — don’t expect them to take cataract surgery by storm anytime soon.

Gaining traction
Our survey respondents say premium cataract services have definitely gained traction over the decade they’ve been available. The one that’s grown the most is correction of astigmatism, the decline in vision that happens when the cornea is oblong rather than spherical.

The most popular way to attack astigmatism is via toric intraocular lenses, designed to compensate for corneal astigmatism as well as refractive error. In a typical facility doing cataract surgery, 11% to 20% of all patients receive these lenses. “Our toric patients are routinely ecstatic,” says a facility manager.

A solid number of patients also receive arcuate corneal incisions, incisions in the cornea itself aimed at altering the curvature to make it more spherical. In the typical facility, 1% to 10% of patients receive these incisions. “We seem to perform many astigmatism procedures — limbal-relaxing incisions with or without toric lenses,” says anesthesiologist Tod Tolan, MD, of Westside Surgery Center in Portland, Ore.

Presbyopic IOLs — designed to let patients see both near and far, like bifocals — are the second most popular premium service. Up to one of every 10 cataract patients ends up opting for these lenses.

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