Join White as he discusses the history of cataract surgery and where femtosecond laser-assisted cataract surgery, or FLACS, fits in. He also explains what he believes to be follies of FLACS and why some people continue to use this procedure. Disclaimer :09 Intro :24 Today we’ll talk about femtosecond laser-assisted cataract surgery, or FLACS :36 Financial disclosures :57 The history of cataract surgery and where FLACS fits in 1:21 The lens supplies about 1/3 of the focusing ability of the human eye 3:35 Scheie Eye Institute 5:42 The discovery of poly(methyl methacrylate) 6:14 Extracapsular cataract extraction 7:14 Cataract surgery moves almost entirely to posterior chamber 7:44 The YAG laser 18:40 Phacoemulsification 19:21 All of these procedures were paid for by health insurance 11:41 The Crystalens 17:00 A petition for patients to have the right to pay to upgrade their implant experience 17:37 The era of refractive cataract surgery 19:03 A false timeline 19:32 Comparing things properly, you find a small difference between two surgeries 22:29 The impressive engineering of femtosecond lasers 23:30 Why do people use the femtosecond laser surgery? 24:53 I do a bit of work as a defense expert in malpractice cases 26:42 There are some bright spots here 29:21 Calling out two groups who don’t let patients decide whether they want FLACS 30:48 I have respect for them, but I don’t think there is justification for doing FLACS based on outcomes 36:13 Throwing a bone to the proponents of FLACS 37:14 That’s my take on FLACS 38:56 We’d love to hear from you! Send your comments/questions to Dr. White at ophthalmology@healio.com. Follow us on Twitter @Healio_OSN @DarrellWhite Disclosures: White reports being a consultant to Allergan, Bruder, EyePoint, Eyevance, Kala, Novartis, Ocular Therapeutix, Omeros, Rendia, Sun and Tearlab; speaker for Allergan, Eyevance, Kala, Novartis, Omeros and Sun; and ownership in Ocular Science.

Eye Care Out Loud

Folly of FLACS

In this episode, White shares the harsh truths about treating perioperative dry eye, including who, when and for how long. Spoiler: Treated dry eye leads to better outcomes. Disclaimer :09 Intro :24 Treating dry eye around the time of cataract surgery and laser refractive surgery :36 This talk will focus on cataract surgery 1:04 Financial disclosures 1:26 The harsh truths about treating the perioperative dry eye 2:07 Harsh truth #1 3:11 Harsh truth #2 4:11 Harsh truth #3 13:25 Harsh truth #4 14:25 Harsh truth #5 17:17 Harsh truth #6 18:11 Take-home message 25:20 We’d love to hear from you! Send your comments/questions to Dr. White at ophthalmology@healio.com. Follow us on Twitter @Healio_OSN @DarrellWhite Disclosures: White reports being a consultant to Allergan, Bruder, EyePoint, Eyevance, Kala, Novartis, Ocular Therapeutix, Omeros, Rendia, Sun and Tearlab; speaker for Allergan, Eyevance, Kala, Novartis, Omeros and Sun; and ownership in Ocular Science.

Harsh Truths of Treating Perioperative Dry Eye

In this episode, Darrell White, MD, continues his analysis of the impact of electronic medical records (EMR), also known as electronic health records (EHR) on private ophthalmic practices.     Disclaimer :09 Introduction :20 Financial disclosures :36 The impact of implementing an EMR at SkyVision 1:39 Lessons learned from being forced into change 3:50 Would engineers design a cockpit on a fighter jet without having flown in one? 4:45 The spoken word should be the goal in the next generation of EMRs 5:55 Once the focus shifts from the patient to the screen, the quality of that experience plummets 8:20 Can we find a way to have the same medical record on every platform? 9:10 Next, let’s go back and figure out who owns this mess 13:00 Have you ever tried to get a copy of a medical record from an EMR company? 21:00 Somewhere, somehow, some institution needs to say “enough” 23:20 The essence of medicine is finding the right story 24:49

EMR Follies, Part Two

In this episode, Darrell White, MD, takes a deep dive into the recent history of the impact of electronic medical records (EMR), also known as electronic health records (EHR) on private ophthalmic practices.    

EMR Follies, Part One

In this inaugural episode, Darrell White, MD, gives the background of how he came to be Healio.com/OSN’s first podcaster, starting out from blogging, to The Dry Eye columnist to podcaster. While becoming known as Healio.com/OSN’s dry eye disease expert, he delves into his background as an anterior segment ophthalmologist with a cross-interest in business and the ongoing arc of his career. Disclaimer :09 Introduction: “You have been reading my blog posts, haven’t you?” 1:00 It’s great you’re a dry eye expert, but do you still operate? 2:22 Who am I and why should you care what I think? 2:51 The arc of an ophthalmology career 3:23 Starting out in private practice 3:57 How did I get into ophthalmology? 4:45 Thinking about the intersection between health care and commerce 9:10 Finding your voice by taking care of patients 10:40 Lessons learned starting a private practice during an economic recession 11:59 Demographics are on the side of the ophthalmologist 13:25 Making the connection between industry and patient care 14:34 Let’s have a conversation about ideas 14:38 

01 How I came to start a podcast about eye care

In episode 2, Darrell White, MD, gives his opinion on conflicts of interest in ophthalmology. From pens given out by companies to selecting which IOL to use, he puts into context what potential conflicts of are compared with what could be called true conflicts of interest and how it is affecting eye care and medical practice in general. Disclaimer :09 Introduction :25 White’s personal financial disclosures and consulting agreements 2:02 The state of eye care and medicine and what conflict of interest truly means 3:29 Starting with the “absolutely ridiculous bordering on asinine rules” 3:47 Ball point pens, penlights and more 3:54 Lunch provided to staff by industry 6:10 Defining potential conflicts of interest 11:16 Is profit a conflict of interest? 12:00 Conflict of interest in the exam room 14:26 Fluoroquinolones and conflicts 16:05 IOL choice and potential conflicts 17:32 “It’s not a slippery slope; it’s a cliff” 20:33 

02 Thoughts on conflicts of interest in ophthalmology

In Episode 3, Darrell White, MD, discusses how he modeled his new private practice after a “customer-centered” approach. He did not benchmark any medical practices but instead modeled it after successful retail and hospitality enterprises that were known for creating the best customer experience. He sold his employees on the concept by doing “secret shopper” style field trips with his entire staff and sometimes their spouses.  Disclaimer :09 Introduction :25 The SkyVision Story :35 An idea sparked while being sidelined with injury 1:21 Starting a customer-centered organization 3:30 Looking not at other medical practices but businesses centered around customer 4:50 Aside from great outcomes, what sets a practice apart? 7:39 The two things that allowed us to put this into action 11:35 Reviewing the Toyota manufacturing model and how it can be applied to a patient moving through a clinic 12:00 Getting staff buy in to the concept: The SkyVision Consumer Service Field Trip 15:14 

03 The SkyVision patient-centered model

In Episode 4, Darrell White, MD, discusses how and why transparency and price elevation has become so entwined in health care in the U.S. He discusses the impact of these issues on cataract surgery, and what can be done in to address some of the transparency – or the lack thereof – and pricing issues that have become deleterious to the private practice cataract surgeon. Disclaimer :09 Introduction :25 A Colorado law says all health care providers of any type must post their prices :35 Thoughts on transparency in medicine and price elevation in medical care in the U.S. 1:00 Let’s discuss the role of the chargemaster in determining pricing 3:00 The Relative Value Unit makes its way into pricing 4:47 The gag clause in payer contracts and its impact on private practice 9:09 Back to the Colorado law 10:47 Why we can’t publicize our base price for cataract surgery, explained 14:01 What we can do 20:38 

04 Thoughts on price transparency in eye care

In Episode 5, Darrell White, MD, shares his thoughts on why every ophthalmologist in every subspecialty should be aware of the prevalence of dry eye and its impact on eye care. Everyone – including retina specialists need to be aware of dry eye :58 Financial disclosures 1:10 The hot dot in eye care 1:40 The space is growing: More people have dry eye and it’s affecting more of their lives 2:31 Dry eye and presbyopia-correcting IOLs 3:17 White’s personal dry eye story 4:54 Starting a dry eye practice from scratch 7:37 The archetypal patient defined in market research done by Allergan 8:12 The 3-generation decision maker on medical care for the family 9:10 Going from 0 patients on day 1, to more than 5,000 active patients in the first year 11:08 What has changed since then 11:52 Multi-screen lifestyle increasing dry eye population 12:05 The biggest symptom is blurry vision 13:34 The Linda Blair dry eye patient 14:41 Listen to your patient 15:56 Treating meibomian gland disease Diagnosing dry eye 17:50 Treating the dry eye patient 18:51 Artificial tears 19:00 Hypotonic tears 19:30 Restasis and Xiidra 20:56 

05 Why you should treat dry eye

In this episode, Darrell White, MD, discusses Omidria and how and why it’s used in cataract surgery. He also shares his thoughts on the pass-through status of this product and others and where things are headed.     Disclaimer :09 Introduction :20 Financial disclosures :50 What is Omidria, how is it used, and why is it controversial? 1:40 Along came floppy iris syndrome 2:10 The difficulty in predicting when IFIS will occur 5:09 The importance of pupil size in cataract surgery 7:59 Why people are not using Omidria 10:50 What makes Omidria controversial 12:50 Background on the pass-through regulation 13:22 How the price is set and how it is paid for 14:13 A 3-year deadline and use it or lose it funds 18:10 What happens when passthrough ends 20:26 What happened in December 2017? 24:41 The pass-through extension 26:30 Mass confusion over when the 2-year period begins 27:41 Omeros is not the bad actor here 29:47 Congress hasn’t done its job 30:33 A decision needs to be made one way or the other 32:13 And about mitomycin C 33:56  

06 Pass through pratfalls

Listen to Darrell White, MD, discuss out loud what everyone else is thinking about in the eye care space.