Premium IOL and Cataract
Co-ManagementJ. Alberto Martinez, M.D.
Visionary OphthalmologyOctober 3, 2010
Testimonial
OUTLINE
THE MARKET AND THE OPORTUNITY
ETHICAL CONCERNS
TECHNICAL ASPECTS
LEGAL
SURGICAL
POSTOPERATIVE CARE
The Graying of America
Another boomer turns 50 years of age every 7 seconds
They represent the majority of the US workforce
They are the US economic engine
13 trillion in assets ( 50% of US asset base)
Average life span of 78.5 men, 82.5 women
As they age: glaucoma, diabetic eye disease and cataracts
The graying of America
Are you prepared to meet boomers health care challenges?
Are you current with technological advances?
Are you embracing the newest ophthalmic technologies?
Their increased expectations regarding outcomes is unprecedented!
We can not afford to wait. This wave has come to shore!
Ethical Concerns
Ethical concerns are absolutely above any considerations
Needless to say, the patient’s welfare must remain the top priority of the MD-OD team
World class outcomes can not be compromised by transfer of care
Team approach must benefit the patient first and MD-OD team second.
Legal concerns
Co-management more common but still controversial
It is critical that any c0-management relationship be ethical and compliant with all legal requirements
Professional societies including AOA have guidelines
Fundamental: no agreement to refer back. Must be based on patient choice
Legal Concerns
Patients must understand clearly who can provide post-op care
Patients must choose to return to OD and sign a statement
Work with a knowledgeable attorney
Medicare rules are clear on the amounts paid for surgery and for post-op care
OD must receive fair market value for their services
Legal Concerns
Patient must be informed about the amounts paid to each provider
Visionary Ophthalmology will develop a mechanism to allocate appropriate amounts
Premium IOLs are most complex c0-management arrangement for it involves covered and non-covered services
VO is committed to develop an ethical, legal and fair co-management practice.
High Technology IOLs
Many IOLs available. Choosing is a complex decision.
Surgeons need to take into account:
Patient’s desires and epectations
Status of the non-operative eye
Presence of any comorbidities
Potential risks
Spherical aberration occurs when light rays are over-refracted at the periphery of a lens system,resulting in a region of defocused light which candecrease image quality.
The Problem: Spherical Optics
*Smith G, Atchinson D A. The Eye and Visual Optical Instruments. Cambridge University Press, Cambridge, United Kingdom. 1997;667.
Aspheric optics align the light rays to compensate for
positive corneal spherical aberration, resulting inenhanced image quality.
The Solution: Aspheric Optics
*Smith G, Atchinson D A. The Eye and Visual Optical Instruments. Cambridge University Press, Cambridge, United Kingdom. 1997;667.
Clinical improvements
demonstrated over spherical
control lens include:• Improved functional
vision • Increased contrast
sensitivity• Reduction of
spherical aberration and total high order aberrations (HOAs)
Benefits of Asphericity
Why Toric IOL?
The AcrySof® IQ Toric IOL offers cataract surgery patients
with astigmatism:
Reduction of residual refractive cylinder
Improved uncorrected distance visual acuity
Increased spectacle-independent distance vision
Selection criteria for Toric IOL
Preoperative regular astigmatism
CCC possible
Intact capsular bag
Precautions in patients with pre-existing ocular disease conditions
Careful consideration in the cases of those with prior corneal refractive surgery
AcrySof® IQ Toric IOL isdesigned to
accommodatea variety of cataractpatients with
astigmatism
A wide range of cylinder powers means more candidates can benefit from AcrySof® IQ Toric
IOL
Designed for a Wide Range of Astigmatic Patients
63% of patients achieved ≤0.50 diopters of residual refractive cylinder1
87% of patients achieved ≤1.00 diopters of residual refractive cylinder1
Dramatically Reduces Residual Refractive Cylinder
The AcrySof® IQ Toric IOL:
Builds on a long line of innovation from Alcon
Takes the trusted platform for precise astigmatism correction and adds the enhanced image quality of an aspheric lens
The Next Step in Toric Technology
Presbyopia-correcting IOLs
Crystalens: an accomodating IOL. Reversible and unpredictable
Rezoom: A refractive mutifocal IOL (AMO)
Restor: Difractive IOL (Alcon)
Tecnis: Difractive IOL (AMO)
1Q08 2Q08 3Q08 4Q08 1Q09 2Q09 3Q09 4Q09 1Q100%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
49.5 46.5 45.4 45 47.453.1 54.5 57.5 54.7
18.517.5
13.27.4 7.4
4.7 2.72.3
2.4
3236
41.445.5 43.4
36.3 34.429.3 27.2
1.7
5.9 8.410.9 15.2
AcrySof® ReSTOR® ReZoom* Tecnis MF* Crystalens*
Survey Share by Quarter
Perc
en
t of
Su
rvey S
hare
US Presbyopia-Correcting IOL Survey Share
Source: Market Scope Quarterly Cataract Update* Trademarks are the property of their respective owners.
Two Different Add Power Options
SN6AD3Add Power: +4.0 DSpectacle Plane: +3.2 DRange: +10.0 D to +34.0 D A-Constant: 118.9
SN6AD1Add Power: +3.0 DSpectacle Plane: +2.5 DRange: +6.0 D to +34.0 D A-Constant: 118.9
Source: AcrySof® IQ ReSTOR® IOL Package Insert.
AcrySof® IQ ReSTOR® IOL +3.0 D was specifically designed to: Maintain existing
optical design characteristics and manufacturing processes
Move near vision distance out 6-7 cm
Improve intermediate vision without sacrificing distance and near1
True Performance at All Distances
Source: AcrySof® IQ ReSTOR® IOL Package Insert.1.Maxwell A, et al. Functional Outcomes After Bilateral Implantation of Apodized Diffractive Aspheric Acrylic Intraocular Lenses with a +3.0 or +4.0 Diopter Addition Power. J Cataract Refractive Surg. Vol. 35, December 2009.
Patient Education
Define• Clouding of the
natural lens that allows less light to pass through to the retina
Symptoms• Blurred vision• Dull colors• Poor night vision• Sensitivity to light
Treatment• ONLY treatment is to
have it surgically removed and replaced with an artificial lens
Begin with the Problem: Cataracts
Take into account: Pathology Lifestyle Astigmatism Preexisting ocular conditions, i.e. dry
eye
Consider Their Needs
Before they leave the office, patients should have:
Educational materials on cataracts and the procedures
Materials that explain their IOL options A follow-up appointment for their cataract
surgical evaluation
Keep Them Informed
Post Operative Care
• Measure visual acuity Test all distances if the patient has a
presbyopia-correcting IOL
• Look for a quiet anterior chamber
• Continue antibiotic, steroidal and NSAID therapy
• Treat dry eye aggressively
What to Expect After Surgery – Day One
VO is committed to educating co-management physicians to provide seamless care.
Mini-fellowships to include:Day one post-op care at VOThree week post-op visit at VOPre-op evaluation and choosing the apropriate
IOLOR visit at our ASC to learn the technical issues
associated with Toric and Multifocal IOLEducational process tailored to individual needs
Educational Process for Optometrists
Premium IOLs are not only great technology to offer patients but can have a significant financial impact in
your practice as well
Financial Rewards
“To be on the cutting edge of optometry, you need to
be on the cutting edge of ophthalmology.”
- Richard Van De Velde, O.D.
Imhoff Eye Center Brunswick, GA
Today’s optometrist provides…• Patient care at any age• Patient support • Patient education for all conditions
Today's Optometrist
Testimonial