EnVision Summit 2026: The benefits of office-based surgery

Inder Paul Singh, MD, spoke in a variety of sessions at Envision Summit 2026 in Puerto Rico, one of which being on office-based surgery (OBS) in ophthalmology. His main goal is to clarify misconceptions about OBS and explain how it fits alongside ambulatory surgery centers (ASCs) and hospitals, rather than replacing them.

Singh emphasized that the discussion is not about choosing ASC versus hospital versus OBS. He personally uses both an ASC, in which he is part owner, and an office-based surgery suite, selecting the setting based on patient and procedural needs. However, he highlighted several key advantages he has observed with office-based surgery.

First, he stressed that patient experience and satisfaction are significantly improved in the OBS environment. A major factor is the continuity and accountability of staff: the same team sees patients through pre-op, intra-op, and post-op, which reinforces their understanding of the patient’s journey and the importance of each step. Patients are already familiar with the office and staff before surgery, which helps reduce anxiety.

Another crucial difference is anesthesia and sedation. In the office-based setting, they avoid IV sedation, instead using oral sedation—commonly 5 mg of Valium in about 90% of patients—combined with topical anesthesia. Without IV placement or related pre-op processes, patients arrive with a lower baseline stress level, and the pre- and post-operative time spent in the facility is shorter than in hospital or ASC settings.

Singh also underscores the flexibility of scheduling in OBS. Unlike ASCs, where surgeons must often work within rigid block times, an office-based suite allows rapid response to urgent or add-on cases—such as retained lens fragments or glaucoma patients with a flat anterior chamber. He can simply open the OBS suite and address these problems promptly, which changes the patient’s experience compared to waiting for ASC availability.

He noted that, beyond routine cataract surgery, they successfully perform glaucoma, cornea, oculoplastic, and even some retina surgeries in the office setting. This breadth of procedures can be managed without the constraints of fixed ASC schedules, allowing adaptations to both surgeon and patient schedules.

Cost is another important theme. For premium service packages—including ICLs and other refractive procedures—OBS enables the practice to design comprehensive packages and lower overall costs, making advanced options more accessible and appealing to patients.

Singh concluded that while ASCs remain valuable and necessary, the addition of office-based surgery has been a fantastic enhancement to their practice, offering multiple benefits in terms of patient satisfaction, efficiency, flexibility, and cost-effectiveness.