Disclosures: Jackson reports he is a consultant for Johnson & Johnson, Sight Sciences and Alcon.
October 08, 2020
3 min read
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Redefining the ‘new normal’ for premium surgeons

One premium practice is experiencing a bump in dry eye treatments as cataract surgery cases slowly return.

Disclosures: Jackson reports he is a consultant for Johnson & Johnson, Sight Sciences and Alcon.
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It is no secret that COVID-19 created not only a global pandemic, but a drastic change in the life we know and love as premium surgeons.

Mitchell A. Jackson
Mitchell A. Jackson

Unfortunately, 2020 has brought an unthinkable chain of events that started March 17 for this premium surgeon, when my entire cataract surgical schedule of 23 cases was scratched. In the final weeks of May, I started back to a schedule of three to five cataract cases daily, and finally in early September, I reached close to my 90% case load of pre-COVID numbers. So, that is the good news.

Pre-COVID, my femtosecond conversion was approximately 86%. This remains close at a surprising 74% level post-COVID, but my premium IOL upgrades are still struggling at an average of 18% compared with 42% pre-COVID. The premium IOL surge and refractive surgery bump have occurred in many markets but vary geographically and have not hit home yet.

With recent events, my small town of Antioch, Illinois, where I have lived for nearly 3 decades, had instituted a curfew of 8 p.m. in fear of riots and looting, so the fears of many of my patients remain. I recently attended a Chicago Cubs doubleheader sitting on the Wrigley rooftops, with social distancing and other safety measures, that nearly brought tears to my eyes, not because the Cubs lost both games, but because Wrigleyville looked like Armageddon with an empty Wrigley field, as if I were watching professional players in a Little League game. The surrounding communities of this large city are still economically devastated with all of the 2020 craziness, making me realize the “new normal” is not even close to normal at all. The realization became a realistic expectation to me as a premium surgeon, no different than trying to set realistic expectations for my patients regarding their surgical outcomes. The economy is still not thriving, explaining why my premium numbers are still lacking.

The good news is my dry eye spa treatments are better than ever, and patients who are upgrading to premium IOL options are choosing to have a variety of dry eye therapies before surgery at higher levels than pre-COVID. As Darrell White eloquently devised the term “MADE” (mask-associated dry eye) in one of his Healio/OSN blogs, patients are realizing the severity of their ocular surface issues. As presented by Jennifer Loh at the virtual American Society of Cataract and Refractive Surgery meeting in May, my results with TearCare (Sight Sciences) treatments are matching those outcomes of the OLYMPIA study with improved tear breakup times, meibomian gland secretion scores and better ocular surface index scores no worse than seen with LipiFlow (Johnson & Johnson Vision) treatments. Our dry eye spa offers TearCare, LipiFlow and iLux (Alcon) treatment options catered to the specific ocular surface needs for our premium IOL and refractive surgery patients. Meibomian gland device treatments have become the “new normal” in my practice since COVID in improving the ocular surface before premium cataract and refractive surgery.

So, the good news continues as our practice is about to integrate the Light Adjustable Lens (RxSight), which will transform our “legal to drive” lifestyle category to near-guaranteed distance vision outcomes and, when combined with dry eye spa meibomian treatments, a near-perfect premium outcome. My expectation is that this technology will give the much-needed bump as seen in other parts of the country in my premium IOL armamentarium despite COVID. The “new normal” has not provided many guarantees these days, but if we can promise such with distance vision outcomes with the LAL technology, maybe a “new normal” is coming to premium surgeons.

In summary, the “new normal” for all of us premium surgeons differs depending on what part of the country we practice, but no matter what, it is being redefined daily. To end with a positive note, I finally operated on my last two COVID cataract casualties from March 17 surgery cancellations in September — only 6 months late, but I guess a “new normal” is here to stay. Stay safe to all my premium surgeons.