A Brisbane eye clinic has published a new paper showing a cost-reduction of 35% per patient when using the ZEISS EQ Workplace digital cataract workflow for toric IOL planning when compared with a manual approach.
The study by Dr Matthew Russell and optometrist Ms Inez Hsing, from OKKO Eye Specialist Centre, was published in Clinical Ophthalmology on 25 May 2024, and evaluated the efficiency and associated costs of EQ Workplace alongside a manual cataract workflow system for patients with astigmatism presenting for cataract surgery.
EQ Workplace is a digital surgical planning tool that allows seamless, automated data access and transfer. The technology also helps to protect against never-events through transcription errors, and allows access to patient data from anywhere in the clinic.
The study involved 60 patients with bilateral cataract requiring toric IOLs. Thirty were assigned to go through the manual cataract workflow while the remaining 30 progressed through the digital workflow using EQ Workplace running on FORUM.
According to the authors, each step of pre-operative data acquisition and analysis was timed. Steps in each workflow were divided into presurgical planning time and total workflow time, the latter including the time required to input toric data into ZEISS CALLISTO eye system where markerless toric IOL alignment occurs. Secondary outcomes included staff costs within each workflow.
Dr Russell and Hsing found the median presurgical planning time using EQ Workplace was 6.51 ± 0.65 minutes, while for the manual workflow it was 12.32 ± 0.56 minutes (p < 0.001).
Similarly, median total workflow time using a digital workflow process was 6.93 ± 0.57 minutes and 13.49 ± 0.47 minutes using a manual workflow process (p < 0.001).
“Evaluating the staff remuneration during presurgical planning and the operating costs associated with running EQ Workplace, there was a cost-reduction of 35% per patient when using the digital cataract workflow process,” the authors wrote.
“Using a digital cataract workflow process is more efficient and provides staff cost-savings compared to a manual workflow process when planning for toric IOL implantation.”
The authors noted their findings supported other studies showing a digital workflow in cataract surgery is beneficial. Brunner et al reportedly compared a manual approach of biometry assessment, data export, IOL calculations, and surgery time to a digital cataract workflow with digital data transfer and found the manual process took about 23 minutes compared to about 19 minutes with the digital workflow (p < 0.001).
“In [our] study, we specifically focused on the processes involved in planning for the implantation of toric IOLs and did not include surgical time. Our results suggest that a digital workflow not only reduces time and cost, thereby allowing support staff to be more efficient and increasing clinic throughput, but it also invaluably offers increased peace of mind by lowering the risk of transcription and human error,” Dr Russell and Hsing wrote.
They also said the potential improvements in clinic staff efficiency and cost-savings associated with EQ Workplace offset the initial investment and subscription fees associated with running and maintaining the platform.
“Moreover, while outside the scope of this paper, we believe that the cost-savings of AU$10,000 (US$6,600) is conservative when considering the mitigation of transcription errors and the potential costs associated with surgically rectifying an incorrectly positioned IOL,” they added.
“As the role of digital workflows is likely to increase, surgeons will continue to need secure and trustworthy processes that can meet the demands of increased cataract surgical rates and patient expectations. Future investigations comparing the refractive outcomes and toric axis alignment of a digital workflow against a manual workflow are warranted.”
Addressing limitations
The authors noted the study was not without limitations, including the possibility of inherent bias from sequential assignment of patients to each workflow, as opposed to adopting a randomised approach. However, any learning effects that could have confounded results would have existed within each workflow, they said.
Additionally, there were different toric IOLs chosen across the patient population. The majority of toric IOL models were the same in both groups, but the authors did not evaluate the surgical time needed to implant the lens, instead only the time it took to prepare for the implantation. Therefore, it was unlikely the choice of IOL would have impacted results.
“It was also not possible to compare the efficiency of the ZEISS Cataract Workflow against other digital cataract workflows—to the best of our knowledge, ZEISS Cataract Workflow was the only commercially available fully digital cataract solution in Australia at the time of the study. Overall, we feel that these limitations are more than offset by the real-world component of this study,” they said.
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