New preloaded IOL delivery system affords operational, economic efficiencies

Take-home:

A preloaded IOL system shaved about 1 minute and 2 seconds from each cataract case performed at a single surgical site by reducing preoperative lens-related preparation activities.

By Nancy Groves; Reviewed by David R. Hardten, MD, FACS

Minneapolis-A preloaded IOL insertion system (Tecnis iTec, Abbott Medical Optics) allows the surgeon to implant a one-piece aspheric acrylic IOL (Tecnis) without manual loading.

This creates time savings in intraoperative workflow and may also reduce the stress on technicians or surgeons who have been responsible for loading IOLs, said David R. Hardten, MD, FACS, a Minneapolis surgeon and principal investigator for a study of the system. Further, the risk of contamination will be lower.

With the preloaded device, a series of lens-related prep activities can take place in parallel with the surgical procedure, which should reduce or eliminate several potential bottlenecks, said Dr. Hardten, who is in practice with Minnesota Eye Consultants.

Overall, use of the system saved a median of 1 minute and 2 seconds per case performed at a single surgical site as part of a multicenter study. The number of preoperative lens-related activities such as inserter preparation and assembly was reduced, resulting in a 7.7% (0:00:39) reduction in operating room-setup time and an 8.7% (0:00:33) reduction in total surgery time.

Study of efficiencies

The operational and economic efficiencies of the preloaded delivery system are being evaluated in an observational study in the United States, Canada, and France. Dr. Hardten reported on results from a surgical site in Perpignan, France, involving one cataract surgeon and two operating rooms. Results from all sites should be available later this year.

The study endpoints are whether the system reduces staff, surgeon, and/or overall case time for routine cataract cases; do observed time savings correspond to operational changes over a 2-month period, such as increased patient throughput or changes in staff scheduling; and do changes in site operations lead to improved profit margins over a 2-month period.

At the French site, 66 cataract surgery cases were observed and 47 met inclusion criteria for the study and analysis. The preloaded inserter was used in 20 cases and the manual inserter in 27. The combined median case time was reduced by 5.1% using the preloaded versus manual inserter; the times were 19:07 mm:ss and 20:08 mm:ss, respectively. The combined median time savings per case with the preloaded inserter was 1 minute and 2 seconds. If the preloaded inserter was used in 100% of the cases performed at this site, in theory one more case could be added for every 19.8 cataract procedures performed, Dr. Hardten said.

In other settings, the time savings would depend on the daily caseload and flow.

“Anything we can do with time savings can help,” he said. “We try to maximize all the different aspects of the procedure, and some of the things that we do to save time have benefits, while some have tradeoffs. Here, there’s no downside to it to save that extra time.

“There is also the upside of less stress about the loading process for the technician or surgeon who is loading the lens,” Dr. Hardten added. “I’ve used several preloaded lenses in the past, but there’s typically been an issue with some aspect of it. I’ve been using this one for about a year, and I’ve been very happy with it and haven’t had the kind of issues with it that I’ve had with some of the other preloaded designs.”

David R. Hardten, MD, FACS

P: 612/813-3600

E: drhardten@mneye.com

Dr. Hardten is a consultant for Abbott Medical Optics (AMO) and principal investigator for this AMO-sponsored study. The system has been approved in the United States, but not yet released commercially.