The retina space is evolving thanks to new technology that is changing the way professionals deliver care, whether that means offering the ability to perform new procedures in the office or providing more virtual or hybrid care.
The word “disruptive” can have a negative connotation and often creates confusion, but in almost every case, society benefits from disruptive technology, noted Dr. Reginald Sanders, a retinal ophthalmologist at The Retina Group in Washington and moderator of a panel on transforming technologies in retinal care.
Sanders moderated a discussion at 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 the Retina Center in Texas; and Jonathan Feistman, MD, of NYC Retina, on 3 transformative technology trends in the retina space.
First, they covered office-based retinal surgery, which had been tried in the past but had not gained much traction on a large scale. However, improvements in technology have caused some practices to reconsider the idea of office-based retinal surgery, Eichenbaum explained. His own practice, based in West Florida, has not actively considered implementing this because he has good access to several ambulatory surgery centers (ASC).
Qureshi’s own practice, based around Dallas, Texas, hasn’t had that discussion either, but he highlighted some of the concerns and limitations of office-based retinal surgery. For example, only certain procedures can be performed safely in an office-based system, and offices typically do not have an anesthesiologist available. In addition, he noted, practices that create this will take certain risks related to complications.
However, Feistman isn’t just excited about the idea of creating office-based retinal surgery—his practice actually created it in May 2022. Practicing in New York, there was a big need for it in the office because they were being pushed into operating rooms (OR) and surgical centers.
“It’s getting harder and harder to find time for OR” at a time when the cases they have are increasing. He acknowledged that for practices with access to an OR or ASC, it wouldn’t need to be created, but for those practices that “we feel like we’re dangerously delaying cases just because of the availability of the OR, I think an office-based OR actually could to eliminate this OR availability factor.’
His practice opened its office operating room on May 24. The day before his session, Feistman said he was on his way to ASRS when he got a message from a referral about a patient at 9 a.m., and Feistman was able to take care of the patient right away and was done with the case by 11 a.m.
“So it’s a dream come true for me to just be able to get it done and not have to look for OR time,” he said.
Echoing Qureshi’s perspective on risk, Feistman acknowledges that patient selection is important when opening an office-based surgery center. A patient who is very sick and may have complications is not someone you want to work with in the office, but a healthy patient who needs urgent care would be a good candidate.
The second theme was the consolidation of retinal 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 a consolidation trend that has been going on for decades.
Consolidation helps with management and billing costs, builds economies of scale that are useful for negating with drug manufacturers and insurance companies, and creates efficiencies.
“I do not think [consolidation] something we will ever be able to escape from,” Qureshi said. “I see this as an ongoing trend that will continue, as opposed to something to be afraid of.”
While Eichenbaum sees the benefits of consolidation and growth, he also sees resistance from younger doctors who see the introduction of investors and larger networks reducing compensation.
“I’m seeing a whole new trend of doctors creating practices because they don’t see the benefit of consolidation at the individual level,” he said. “So it will be very interesting to see how the interplay of these 2 trends plays out over the next 5 to 10 years.”
Consolidation trends, like many other trends, seem to be locale-specific, according to Feistman, who noted that New York hasn’t seen many PEs, but hospitals are snapping up and buying practices. One key aspect that practices will need to consider when consolidating is where patients come from, and if consolidation means practices that may have sent referrals in the past can no longer refer patients to independent practices, there may be more great pressure.
One change that all practices are feeling is the move to a more virtual office. Staffing is and has been a huge issue for practices, Feistman said. Although doctors work hard to see patients and provide quality care, they still rely on office staff. There is a clear desire for these staff to work from home or have a hybrid model.
Being based in New York, Feistmann’s office doesn’t have much room for staff because the space is small, but now some of that staff can work out of the office and be just as, if not more, productive.
“It’s an interesting and new angle that we can use when we’re with our current staff or potential staff,” he said. “Before the pandemic, [working remotely] it was something we didn’t even consider or think about.
The virtual office also ties into telemedicine and virtual care, Eichenbaum added. Younger patients who are starting to come to his practice are more interested in using technology and may want more virtual visits or to be able to visit the practice for imaging when the doctor is not available and have a video call more late to review the images.
“I think it’s going to be a transformative thing after the pandemic for all of us,” Qureshi agreed. “And we have to be open to that.”
While there are some services or tasks that need to be done in the office, using a hybrid model with patients like the one Eichenbaum described can be more efficient and effective and also reduce clinic volume, Qureshi said.
Sanders closed the panel with his own experience with virtual scribes, which was initially met with resistance but ultimately successful. Some weeks he may have virtual scribes based in South Carolina, New Jersey, or even locally.
“This 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 can now be done virtually,” Sanders said.