Quick Hits

The refractive cataract surgeon in a COVID-19 world

Serving patients in this unprecedented time means rethinking how you do business.

I am a refractive cataract surgeon in south Florida who lived and practiced through the financial crisis of 2008. We did fine — people still wanted cataract surgery, and though LASIK numbers dipped, the office was open for business. People still needed to see to watch their net worth tumble, dial their money managers or call their banks, and they still lined up to have their glaucoma testing, routine eye exams and such.

But this is 2020. We are a specialty that is recession-proof, but apparently not pandemic-proof. Go figure. Here we are, sheltering in place and forced to cancel “elective” surgery to preserve personal protective equipment and reduce our patients’ potential exposures. Strange times, indeed.

Ophthalmology Management is offering continuous coverage of the COVID-19 pandemic and its effect on ophthalmology online. Visit and click on the “COVID-19 Updates” button under the “Resources” tab for more on key legal issues facing practices, how retina practices can adapt to the pandemic and additional updates and guidance.


My clinic that was mostly cataract and LASIK evaluations is now a resident emergency clinic. Time to brush off that “Wills Eye Manual.” After furloughing 90% of our staff and closing three of our five offices, we are reduced to a skeleton crew of mask-wearing providers.

Beyond vision, we can further educate and inform. We can talk with our patients about why masks are important, encourage them to stay home and demonstrate social distancing in our offices. We can let them know we will still be here to serve their visual needs, but for now we want them to stay home unless they are in pain or losing vision.


When we are not removing foreign bodies, we have also started doing telemedicine exams, both as a service and a revenue-generating activity. Telemedicine visits are not going to keep our practice open, however. So, what’s next and how do we get there?

Our clinics will probably not be as busy once we open back up for surgical evaluations, at least not initially. Some providers are doing initial refractive consultations via telemedicine already, engaging with their communities online. This is a downstream investment in future surgical patients that may provide many benefits once the clouds lift from our current situation. Others are planning satellite offices where telemedicine may continue to be a part of surgical evaluations. This may be a paradigm shift in how surgeons expose themselves to geographically disparate patient populations.

We have chosen to reach out to our referring doctors to maintain those relationships and be available for emergency care during this time. We are happy to serve the community in this way and bridge the gap from needed and urgent care now to desired visual goals in the future.

Social media postings can maintain market visibility during this time as well as inform and educate our patients. There is considerable inconsistency in messaging and misinformation that we can help dispel during this time. We are physicians first and ophthalmologists second. This time has been a reminder of the importance of physicians in holding communities together during times of crisis.


We all anticipate pent-up surgical demand later this year when our clinics open again. Will our clinics be full, though? Will patients be reluctant to go outside as the risk of a second wave looms? Will we still be social distancing in our waiting rooms in 6 months? Are practices going to be using pagers like the local Olive Garden to tell patients waiting in cars that it’s their turn to be seen?

The economic impact of this pandemic will have long-lasting ripple effects for the refractive cataract surgeon. We will all need to play financial catch-up this year, potentially working longer and harder to meet our patients and practice needs, including extending hours or adding weekend clinics. It will be even more important to educate our patients regarding the benefits of astigmatism correction or presbyopia-correcting lenses as the value proposition has to be high for any perceived “luxury” expenditure in tough economic times.

But we will get through this. People want to see. A Research America online poll of 2,000 respondents found a majority considered losing vision equal to or worse than losing hearing, memory or speech ( ). So, we have to remember the value of our profession and the need for those services.

Cataracts will not disappear on their own, and some providers may retire or close shop during this crisis. Those of us still here when the dust settles should be ready to be very busy surgeons to meet our patients’ visual needs. OM


When I read the article “Improving the patient experience” in the February 2020 edition of Ophthalmology Management, specifically the “Measurements/Testing” section that recommended having testing for a cataract evaluation done first, I was in complete agreement. Getting testing done first creates the best patient experience, is the best medical practice and is the best way to schedule visits. The surgeon will have timely, high-quality testing results in order to make the best decision on lens selection with that patient.

If the surgeon and patient decide not to proceed with cataract surgery, any testing (eg, optical biometry) is not billed, preventing unnecessary billing. Requiring patients to wait until after an exam for testing can result in poor quality testing due to disruption of the ocular surface; in addition, requiring the patient to return to the clinic on another day for testing means a potential delay in scheduling surgery, another co-pay for the patient and additional burden for patients who have to travel and have mobility and transportations issues.

What has precluded my practice from scheduling patients this way is the CMS guidance specific to Standing Orders for diagnostic tests.

As we all look forward to the end of the COVID-19 outbreak and a return to normal operations, I hope CMS will reconsider the rules specific to Standing Orders for diagnostic tests necessary for cataract surgery. Having all the important diagnostic testing data available to the surgeon at the start of the patient’s visit truly is the most patient-centric and cost-effective way to care for our cataract patients. I hope this crisis can be a catalyst for reconsidering some billing rules, such has been done with telehealth visits recently. If modified, they can truly be both cost effective and in the best interest of patients.


Janis H. Simpson, CPA
CEO, Spokane Eye Clinic
Spokane, Wash.


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