impact of ora on refractive cataract surgery and the premium channel offering

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  • 1. Impact of ORA on Refractive Cataract Surgery and the Premium Channel Offering 8 Shareef Mahdavi SM2 Strategic Pleasanton, CA 7Intraoperative Aberrometry, a term receiving toric IOLs and/or present- Table 1: Surgeon Demographicsdescribing the use of a wavefront-sens- ing as post-refractive patients. Ining device during cataract surgery, has # Surgeons in Survey: 101 2010, the company changed its busi-been available in the US since 2008. ness model and now allows surgeons Cataract Cases per Month:First commercialized as the ORange Average No. of Cases: 73 unlimited use of the device for aSystem, developer WaveTec Vision (Aliso Range: 8 to 350 fixed monthly fee of $3,000. (Note:Viejo, CA), has continued to develop the Orange/ORA Cumulative Experience in both models, the device was firsttechnology through a series of software Average No. of Cases: 365 acquired as a capital purchase orand hardware modifications to improve Range: 10 to 4,000 lease). This revised approach wid-utility of the device during cataract sur- ened the appeal to surgeons; surveygery. Its ORA System was launched in respondents perform anywhere fromlate 2011; since that time, the companys Table 2: Percent of Time ORA 8 to 350 cataract cases per monthinstalled base of sites and users has Affected IOL Power Selection and use ORA on a population ofexpanded nearly five-fold. n = 21 90-100% patients that include all patients hav- SM2 Strategic was asked to conduct ing refractive cataract surgery. Some n = 35 50-80%a survey of ORA users to better under- surgeons have opted to use the ORAstand the impact of the technology on n = 25 11-50% reading as a quality control check-the cataract practice. Given that ORA is n = 9 DK/NA point on IOL selection over a widea technology that surgeons are using to range of cases. n = 8 < 10%enhance their premium refractive cata- All surgeons continue to per-ract practices, most surgeons using the n = number of surgeons form pre-operative diagnostics anddevice are performing refractive cataract Average Among Surgeons= 59% Average Among Surgeons = 59% begin surgery with an IOL as part of the premium channel However, when they use ORA, theyoffering to patients in their practice. are then modifying the surgical plan based on the intra- This survey focused on how ORA is influencing surgeon operative ORA recommendation the majority of thebehavior in the operating suite and, consequently, how time (59% across the survey sample). Further segmenta-surgeons are using the device to make refractive cataract tion of the surgeon sample reveals that 1 in 5 surgeonsoptions more attractive to patients coming in for surgery. do this 90% of the time or more when using ORA.Of 215 surgeons invited to participate, 47% (101 of 215) According to Denise Visco, I tell my patients, I amprovided data in an online survey. 15% more accurate in selectingTwelve surgeons also took part in a Figure 1: Frequency of ORA your IOL when I use ORA versustelephone interview to further under- Saving Surgeons from when I do not. I tell other sur-stand surgeon motivation to acquire Refractive Surprises geons that you get better at it theand use ORA. Additional demographics more you use it. The distributionof the survey sample can be seen in of usage of ORA over pre-op read-Table 1. The key findings can be sum- ings is shown in Table 2.marized into three main themes, each Similarly, the ability of ORAof which will be explored in the follow- Weekly At Least to prevent a refractive surprise 34% once/monthing sections: from taking place is occurring 36% with greater frequency. As shownFrom Niche to Mainstream in Figure 1, 14% of surgeons Initially offered as a pay per Daily reported that ORA has kept them Rarelyuse technology that would cost 14% from choosing the wrong lens a 14%$150 per case, the first surgeon lot, meaning every week andusers tended to be highly selective perhaps daily. Another 34% of sur-and used the technology on patients n = 93 Never 2% geons indicated this was occurring
  • 2. regularly, meaning once per week. Only 2% of surgeons with other services. The remaining 9% of surgeons do notsaid that ORA has never prevented a refractive surprise. include a charge for ORA in refractive packages either I strongly recommend ORA, noted Michael because of limited access (e.g., ORA is only available at aWoodcock, who has used ORA in more than 3,600 cases. secondary surgery center) or have chosen to use it on allIts required for post-refractive patients without charging separatelypatients and I will not perform surgery Figure 2: Learning Curve for it.on them if they arent willing to have The average fee, weighted acrossORA. 1 MO. all surgeons in the survey regardless of Mitch Jackson, with nearly half his < 30 TIME/NO. OF CASES whether or not they have a separate CASES TO REACH COMFORT LEVELcataract volume being post-refractive fee, was $337 per eye.patients, agrees: ORA changes out- 35 Surgeon conversion of patient inter-comes. I am using it on all my post- est to a toric or presbyopic implant hasrefractive surgery cases so as not to 30 increased significantly, moving fromworry about what we used to think of 31% to 38% of all cases (see Figure 4). 25as difficult cases. Fewer enhancements ORA gives me a lot more confidence, 3 MOS.mean less chair time and less time spent 20 50-100 4-6 MOS. especially with the toric lens. I feelon fixing the primary procedure with CASES 100-150 more comfortable treating post-refrac- CASES NOTeither an IOL exchange, piggyback 15 THERE tive eyes as I am better able to triangu-IOL, LRIs, and/or laser vision correc-


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