Transformative Technology Is Driving Change in Retina Care Delivery

The word “disruptive” can have negative connotation and often creates confusion, but in almost every case, society benefits from disruptive technology, noted Reginald Sanders, MD, a retina specialist ophthalmologist at The Retina Group of Washington and the moderator for a panel on transformative technologies in retina care.

Sanders led a discussion during the American Society of Retina Specialists (ASRS) 40th Annual Scientific Meeting with David A. Eichenbaum, MD, FASRS, of Retina Vitreous Associates; Jawad A. Qureshi, MD, MBA, of Retina Center of Texas; and Jonathan Feistmann, MD, of NYC Retina, on 3 trends of transformative technology in the retina space.

First, they covered office-based retina surgery, which has been tried in the past, but had not gotten much traction on a large scale. However, improvements in technology have led some practices to revisit the idea of office-based retina surgery, explained Eichenbaum. His own practice, based in West Florida, has not actively considered implementing this because it has good access to a few ambulatory surgical centers (ASCs).

Qureshi’s own practice, based around Dallas, Texas, also has not had this discussion, but he did highlight some of the concerns and limitations of office-based retina surgery. For instance, only certain procedures can be done safely in an office-based system and typically offices will not have an anesthesiologist available. In addition, he noted, practices that set this up will take on certain risks related to complications.

However, Feistmann is not just passionate about the idea of setting up office-based retina surgery—his practice actually set it up in May 2022. Practicing in New York City, there was a major need for this in office because they were getting squeezed out of operating rooms (ORs) and surgery centers.

“It’s getting harder and harder to find OR time” at a time when the cases they have are increasing. He acknowledged that for practices with access to an OR or an ASC, this wouldn’t be necessary to set up, but for those practices that “feel like we are dangerously putting off cases just because of OR availability, I think that an office-based OR can actually eliminate that factor of OR availability.”

His practice opened its OR in the office on May 24. The day before his session, Feistmann said he was on his way to ASRS when he got a message at 9 am from a referral doctor about a patient, and Feistmann was able to care for the patient right away and was done with the case by 11 am.

“So, my dream came true of just being able to get it done and not have to look for OR time,” he said.

Addressing Qureshi’s point about risk, Feistmann acknowledged that patient selection is important when opening an office-based surgery center. A patient who is very sick and could have complications is not someone he would want to work on in the office, but a healthy patient who needs quick help would be a good candidate.

The second topic was consolidation of retina practices, which has been happening for years, but now private equity (PE) investment is also accelerating, Sanders said. Qureshi agreed that PE is the next step in the consolidation trend that has been happening for decades.

Consolidation helps with managerial and billing costs, builds economies of scale that are beneficial for negation with drug makers and insurance companies, and creates efficiencies.

“I don't think [consolidation] something that we'll ever be able to run away from,” Qureshi said. “I see this as a continuing trend that's going to continue as opposed to something we should fear.”

While Eichenbaum sees the virtues of consolidation and growth, he’s also seeing resistance from younger doctors who see the introduction of investors and larger networks reducing compensation.

“I'm seeing a brand new trend of doctors setting up practices because they don't see themselves benefiting from the consolidation in an individual level,” he said. “So, it's going to be very interesting to see how the interplay of those 2 trends works out in the next 5 to 10 years.”

Consolidation trends, like many trends, seem to be specific to locales, according to Feistmann, who noted that New York City hasn’t seen much PE, but hospitals are picking up and buying practices. One key aspect practices will need to consider with consolidation is where the patients are coming in from, and if consolidation means practices that might have sent referrals in the past are no longer able to send patients to independent practices, there might be more pressure.

One change that all practices are feeling is the shift to a more virtual office. Staffing is, and has been, a huge issue for practices, Feistmann said. While physicians work hard to bring patients in and deliver quality care, they still rely on office staff. There is a clear desire for this staff to work from home or have a hybrid model.

Being based in New York City, Feistmann’s office does not have a ton of room for staff because space is tight, but now some of that staff can be working outside of the office and be just as, if not more, productive.

“It's an interesting and a new angle that we can use when we're with our current staff or potential staff,” he said. “Before the pandemic, [working remotely] was something that we didn't even consider or think about.”

The virtual office also dovetails into telemedicine and virtual care, Eichenbaum added. The younger patient population starting to come into his practice are more interested in using technology and may want more virtual visits or be able to visit the practice for imaging when the physician isn’t available and have a video call later to go over the images.

“I think this is going to be something that's transformative since the pandemic for all of us,” Qureshi agreed. “And we need to be open to it.”

While there are some services or jobs that need to be done in the office, employing a hybrid model with patients like Eichenbaum described could be more efficient and effective and also decrease the volume in the clinic, Qureshi said.

Sanders closed out the panel with his own experience with virtual scribes, which initially was met with resistance, but ended up being successful. Some weeks he may have virtual scribes based in South Carolina, New Jersey, or even locally.

“It is potentially a game changer, and we have to rethink all those things that we thought had to be done in the office—especially if you have limited space—that now can be done virtually,” Sanders said.