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The Truth about Cataract Surgery Performed in an Office: A Cautionary Tale

By: Roger M. Kaldawy, M.D.
Milford Franklin Eye Center

Cataract surgery is a common, safe, and highly successful procedure traditionally performed in hospital settings or specialized ambulatory surgical centers (ASCs). However, some considerations including greed and financial bias have led some surgeons to advocate for performing cataract surgeries in office-based settings. This is while there is plenty of availability for performing  the same surgery in the safety and comfort of an ASC just a few minutes from these surgeons’ offices. There are inherent risks and considerations that patients must be aware of before undergoing such procedures outside of a hospital environment or an ASC. If they ask you to have your cataract surgery in their office, think again.

Lack of Emergency Resources: 

One of the primary concerns associated with cataract surgery in an office setting is the potential lack of immediate access to emergency medical resources. Unlike hospitals or surgical centers, where anesthesia emergency teams and specialized equipment are readily available, office-based facilities may not have the same level of preparedness to handle unforeseen complications during surgery. In fact, those offices have no anesthesia presence at all. In the event of a medical emergency such as sudden changes in vital signs or cardiac arrest, delays in accessing emergency care could have serious consequences for the patient’s health and well-being. Although it may sound hard to believe, those office surgeons want to call 911 if you have a medical emergency while you are having your cataract surgery. And good luck if the emergency crew is too busy or inaccessible!

Infection Control Challenges: 

Maintaining strict infection control measures is essential in any surgical setting to minimize the risk of postoperative infections. However, office-based facilities may face challenges in upholding the same standards of sterility as hospital operating rooms or ASCs. Factors such as limited space, inadequate ventilation, and insufficient sterilization equipment could compromise the cleanliness of the surgical environment, increasing the likelihood of surgical site infections and other complications. Furthermore, an ASC performing thousands of cataract surgeries every year has way more infection control personnel and training compared to an office performing the same surgery occasionally.

Lack of Anesthesia Monitoring: 

Another critical aspect of cataract surgery is the administration of anesthesia to ensure patient comfort and safety during the procedure. While local anesthesia is commonly used for cataract surgery, monitoring the patient’s response to anesthesia is crucial to prevent adverse reactions or complications. In office-based settings, the availability of trained anesthesia personnel and monitoring equipment may be limited and often inexistent, potentially putting patients at risk of anesthesia-related complications such as respiratory depression or allergic reactions.

Lack of Anesthetic Titration: 

Sedation titration allows for the adjustment of sedation levels during the procedure, thereby mitigating the risk of patient awareness during the surgery. Titration involves the ability to administer varying levels of anesthesia, as deemed appropriate. When your surgery is in an office, you will have no IV and no ability to titrate the anesthetics. They give you some sedatives by mouth before you go to the OR. That’s it. The absence of the capability to titrate anesthesia in the office poses a significant risk. You may not be able to hold still for safe surgery. You may remember the entire experience afterward. This, in turn, can cause you significant traumatic stress because of this experience.

Limited Surgical Expertise in an Office: 

Cataract surgery requires precision and expertise to achieve optimal outcomes and minimize the risk of complications. Surgeons who perform these procedures in hospital settings or ASCs often have extensive training and experience in ophthalmic surgery, backed by the resources and infrastructure of a specialized surgical environment. In contrast, office-based setting may not have the same level of track record or access to advanced surgical techniques and equipment. In fact, the entire state of Massachusetts has only 2 offices performing cataract surgery in the office. Compare this to hundreds of well-equipped ASCs and hospitals performing this surgery successfully for decades.

Patient Selection and Follow-Up Challenges: 

Proper patient selection and thorough preoperative evaluation are crucial to identifying individuals who are suitable candidates for cataract surgery and assessing their risk factors for complications. Additionally, postoperative care and follow-up are essential for monitoring the patient’s recovery and addressing any concerns or complications that may arise. In office-based settings, there may be limitations in conducting comprehensive preoperative assessments and providing adequate follow-up care. Even if this selection is perfectly planned and the patient is deemed “low risk for office-based surgery”, unforeseen surprises can happen when no emergency services exist. This can potentially compromise patient safety and satisfaction.

Lack of Approval by Professional Societies: 

Cataract surgery in an office setting is not covered by Medicare and not approved by all major ophthalmology professional societies. In fact, the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery refuse to approve office-based surgery, citing concerns about patient safety.

Legal and Ethical Considerations: 

The decision to perform cataract surgery in an office setting raises important legal and ethical considerations for both patients and healthcare providers. Patients must be fully informed about the potential risks and limitations of office-based surgery, as well as their rights to alternative treatment options and access to emergency care. The surgeon’s choices to perform the surgery in an office based on financial bias should be clearly explained to the patient, more so when a safe surgery center exists and is available minutes away, and when the surgeons are charging patients fees for this office-based surgery.

In conclusion, office-based cataract surgery is not without its risks and limitations. Patients considering this option should carefully weigh the potential benefits and drawbacks.  If your surgeon recommends you have cataract surgery in an office, you are advised to seek a second opinion to make an informed decision. At the Cataract Surgery Center of Milford, a dedicated MD anesthesiologist is present full-time for all procedures, no exception, and your comfort and safety are titrated by using an IV line, which is lacking in the office-based surgery model. You come first. We are available in your backyard and proud to offer world-class cataract surgery closer to home: Here in Milford! In an accredited and licensed surgery center facility, not in an office. Four decades serving our communities and going strong.

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