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The intricacies of adopting new technology in your practice

Digital EditionOphthalmology Times: May 2024
Volume 49
Issue 5

When considering change, patient needs should be at the center of any decision.

(Image Credit: AdobeStock/Kiattisak)

(Image Credit: AdobeStock/Kiattisak)

Adopting new technology is both exhilarating and challenging, as it requires an intricate process of evaluating considerations such as cost, risk, and impact on workflow. More importantly, however, decision-making hinges on the innovation’s potential benefit to patients, including how it enhances care and surgical outcomes.

We have all contemplated adding new technologies to our repertoire because of their novelty, but before leaping into the fray of innovation, a thoughtful assessment of the proposed technology (grounded in your ethos of patient care) must be conducted. The following 6 considerations are paramount for successful integration of innovation.

No. 1: Don’t expect evaluating a new technology to be straightforward

There are often limited real-world data for new technology. In these cases, leverage your relationships with colleagues who have experience with the technology, explore international perspectives when possible, and spend time with the research and development team who can answer any questions you have. Wet labs can also provide valuable insights into how the technology performs in your hands before you use it in the operating room (OR). Due diligence is nonnegotiable and is the first line of attack in such important decision-making.

No. 2: Quantify the impact on patient care and outcomes

Gauge the efficiency of a new technology to improve visual outcomes, patient satisfaction, and long-term vision stability with both objective and subjective measures. How much will you use the technology? What gap does it fill for you and your patients? Will it truly impact patient care and outcomes? We are often faced with a “must-have” or a “nice-to-have” dilemma as we consider new tools and technologies.

No. 3: Assess its financial viability

Once you decide that a technology is in your patients’ best interests and will benefit your practice clinically, it is time to consider some of the obstacles of incorporating it into your practice. The first is financial viability. Do you have the surgical volume to support the technology and pay it off over time?

Some technologies have a well-defined reimbursement pathway, whereas others may demand a more creative approach to financial viability. Fortunately, in the premium services space, we can often charge patients for noncovered services. With refractive cataract surgery, for example, offering technologies such as advanced diagnostics, intraoperative aberrometry, and astigmatism and presbyopia correction can help offset costs and ensure sustainability of the technology within your practice.

I commonly pair a monofocal or extended depth-of-focus IOL with the Ally femtosecond laser (LENSAR, Inc) and laser correction of astigmatism. I also pair a toric IOL with laser guidance for many patients. By offering patients astigmatism correction at the time of cataract surgery, it is an easy way to offset the cost of the femtosecond laser, as patients pay out of pocket for this service.

I prefer laser cataract surgery because it helps reduce complications when I get into the OR. The capsulotomy is already completed, I don’t need as much ultrasound power to remove the cataract, and it is easier to get the lens to sit symmetrically and properly under the anterior rim of the capsule. Patients do not pay extra for these aspects of the laser’s capability, but they do pay for the astigmatism management the laser provides with iris-registered, arcuate corneal astigmatism reduction incisions or toric alignment marks on the cornea or anterior capsule.

However, there are many instances for which technology should be integrated regardless of financial viability. For example, a macular optical coherence tomography and corneal topography are not reimbursable services for cataract surgery, but they are powerful screening tools that can aid in decision-making and IOL technology selection. Additionally, they can decrease the risk for postoperative surprises and enhancements.

No. 4: Identify other advantages

Some benefits of incorporating new technology into your practice go beyond patient care and financial viability, attesting to the nuanced calculus involved in assessing technology. Consider the case of heads-up surgery. Improved ergonomics and reduced surgical strain may not directly translate to billable services, but the technology can help preserve a surgeon’s health and reduce potential neck and spinal injuries compared with a lifetime operating hunched over a microscope.

Heads-up surgery can also allow surgeons to operate more comfortably at higher magnifications, and they now offer image-enhancing filters to aid in situations such as white cataracts and microinvasive glaucoma surgery.

No. 5: Consider workflow

Anytime a new technology is adopted, workflow demands change. Anticipating the need for variations to the infrastructure and accounting for a learning curve can cut down on the time needed for staff buy-in. A steadfast focus on patient benefits and care help pave the way for seamless integration.

Visit surgeons who have been using the technology successfully and look for any potential roadblocks to adoption in your practice. With laser cataract surgery, it’s helpful to see others use the device and learn the benefits of its multiple applications and options for setup. Some keep the femtosecond laser in a separate room, whereas others keep it in the same OR as the phacoemulsification system.

Additionally, schedule time to talk to the company that manufactures the device about how different surgeons use the technology to maximize their time and improve their efficiency. They often have the most experience and resources to help you be successful in integration, both from a clinal and a financial perspective.

No. 6: Consider timing

Adopting only 1 innovation at a time avoids the need to learn the nuances of too many technologies simultaneously. That said, do not view new technologies as mutually exclusive choices but rather as complementary tools in the pursuit of superior patient care. Select the innovation you feel will best elevate your practice, and then build the adoption of other technologies around it incrementally. Surgeons’ buy-in and patience is critical for staff support and adoption, as it may require more work on their part.

Robert J. Weinstock, MD, performs lens surgery and implants an LAL in a patient. (Image courtesy of Robert J. Weinstock, MD)

Robert J. Weinstock, MD, performs lens surgery and implants an LAL in a patient. (Image courtesy of Robert J. Weinstock, MD)

Ultimately, people talk about their cataract surgery experience with family and friends, so adopting technologies that can enhance their perspective is a great place to invest first. The femtosecond laser is ubiquitous for almost all patients because most have astigmatism that can be corrected. In my practice, 70% of patients choose to have their astigmatism corrected and therefore have laser cataract surgery. This easily creates a financially viable model for our practice.

Another recent technology that many surgeons are having success implementing is the Light Adjustable Lens (LAL; RxSight, Inc). It is a great option for patients who are post refractive surgery, those who are interested in perfect distance vision, and those who used monovision contact lenses. The LAL+ also provides presbyopia correction without diffractive optics, offering a level of precision we have not seen before. This technology, coupled with the Ally femtosecond laser, offers patients the most automated, technologically advanced, and precision-oriented procedure that is available today. Eye surgeons are now approaching me to perform this combination when it comes to their own eyes for clear lens replacement and cataract surgery. This pairing affords better outcomes, results in fewer unhappy patients, and comes with less need for IOL exchange and postoperative enhancements. This is a win-win for patients and the practice.


Adopting new technology requires a multifaceted approach that considers the available evidence and the device’s impact on patient care and outcomes, financial viability, workflow, and timing of adoption. Throughout the process of evaluation, we must place our patients at the center.

Word-of-mouth referrals play an integral role in surgical volume. Offering technologies that facilitate a customized, patient-centric approach give you a better chance of building a successful practice in today’s health care environment.

Robert J. Weinstock, MD
E: rjweinstock@yahoo.com
Weinstock is in private practice at The Eye Institute of West Florida in Clearwater, Hyde Park, Largo, St Petersburg, and Westchase, Florida. He is a consultant to Alcon; Bausch + Lomb Corporation; Johnson & Johnson Vision; LENSAR, Inc; and RxSight, Inc.
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