The aphorism “Necessity is the mother of invention” doesn’t really communicate how dire someone’s need can actually be to prompt the ingenious creation of a solution. Many times, things are turning bad, the going is getting rough and your back is against the wall, and this pushes you to find a new way of doing things.

Though the matter isn’t settled, and skeptics will provide well-reasoned objections to the practice of in-office cataract and retina surgery, many proponents of the new surgical approach turned to it as a response to forces that seemed bent on making their surgical lives tougher.

In our cover story on office-based surgery (beginning on p. 48), surgeons who’ve chosen to construct surgical suites in their offices tell stories of working in hospital and ambulatory surgery centers’ operating rooms in which they have no control over which equipment they’re going to use for a cataract case, nurses who can’t identify which ophthalmic instrument is which and staff who can’t locate key pieces of equipment at crucial times. 

The retina community seems to almost have it worse than the cataract surgeons. (Pro tip: Don’t have a retinal detachment if you can help it.) When faced with an emergency retinal detachment, they have to call around and beg hospitals and ambulatory surgery centers on the phone for operating room time as if they’re making some kind of outrageous imposition. Meanwhile, the detachment patient is having an existential crisis as his condition potentially worsens.

Considering what we as consumers pay for our health care, learning what these poor detachment patients and their surgeons have to go through is embarrassing and enraging. In hearing their tales, you can see the necessity that pushes them to give an in-office surgery suite a go. 

This theme of adapting to changing circumstances continues in our feature on interpreting the images generated by optical coherence tomographers (p. 58). With every new technology comes new challenges in working with it, such as the artifacts that can obscure images and confuse OCT users. Surgeons, however, have adapted. Here, they share their ways of dealing with these artifacts when they occur.

In an event more revolution than evolution, I wanted to announce the well-earned retirement of our Medicare Q&A section editor, Paul Larson, MBA, MMSc, COMT. For the past five years, Paul has helped our readers understand the sometimes mystifying world of Medicare coding, covering everything from cataract surgery to dry-eye management. We want to thank Paul for all his hard work, and wish him the best as he embarks on this new chapter of his life!

Taking the reins of the column will be Paul’s colleague at the Corcoran Consulting Group, Mary Pat Johnson, COMT, CPC, COE. Welcome, Mary Pat! Both the staff and the readers of Review are looking forward to learning a lot from you.



— Walter Bethke
Editor in Chief