Vitrectomy discovering its place in office-based surgical suite
January 09, 2026
4 min learn
Over the previous decade, most ophthalmologists have grow to be conversant in in-office cataract surgical procedure, and greater than 130 practices have begun providing the process.
Now, vitrectomy can also be rising as an choice for office-based surgical procedure (OBS).
Even earlier than that concept stirred debate within the ophthalmology group, my follow grew to become the primary on this planet to start performing office-based vitrectomies at full scale. Greater than 3 years later, a dozen facilities have adopted the technique, together with one in Eire.
Whereas conducting vitrectomy beneath oral sedation and a topical anesthetic is a disruptive concept, I’ve saved sufferers secure, snug and calm throughout 1000’s of those procedures, and soon-to-be-published knowledge aggregated from taking part practices will verify that pattern.
I’m obsessed with OBS as a result of I imagine it would revolutionize ophthalmology. By simplifying the regulatory setting, streamlining workflow and granting physicians extra management over their surgical settings, this technique is poised to generate vital advantages for our discipline and the sufferers we deal with.
Preventing inefficiency
Once I launched my follow 7 years in the past, I discovered that gradual hospital turnover occasions made it troublesome to carry out even three vitrectomies a day. And though ASCs have been extra environment friendly, I typically wanted to coach employees there to make use of required equipment.
Most services are additionally affected by a scarcity of anesthesiologists, which incessantly disrupts the scheduling of ophthalmic procedures (Grebbin).
The excellent news is that, by my estimation, 95% of ophthalmic surgical procedures may be efficiently carried out beneath oral sedation with topical ache management. With out the necessity to schedule an anesthesiologist or the additional restoration time sufferers want after normal sedation, I’ve discovered that I’m able to carry out 5 occasions extra vitrectomies than I can in a hospital and double or triple the quantity I can conduct in an ASC.
Enhancing affected person care
- offering the perfect know-how, which I can select with out a capital budgeting committee or different bureaucratic processes;
- enabling emergency surgical procedures to happen as quickly as an hour after prognosis;
- making extra individuals eligible for surgical procedure, as preoperative histories and physicals are usually not all the time obligatory;
- simplifying scheduling for many who have issue ambulating or navigating social or demographic points;
- making surgical procedure extra accessible to people who find themselves uninsured or underinsured. As a result of I obtain enough reimbursement and have the liberty to make my very own billing selections, I’ve been capable of prioritize charity care, which now includes a good portion of my follow;
- facilitating faster restoration. As a result of some instances don’t require a sub-Tenon block, my sufferers typically go away my workplace with out an eye fixed patch and might return to their common actions the subsequent day; and
- avoiding the dangers related to sub-Tenon and retrobulbar blocks, which may embrace hemorrhage and damage to nerves or muscle tissues.
OBS has additionally improved the surgical expertise for my employees members, who higher admire the complexity and life-changing functions of my procedures and have grow to be enthusiastic advocates of the in-office method.
Exploring a brand new protocol
To ascertain a protocol for in-office vitrectomy, I mirrored the ideas I exploit in anterior phase OBS — most significantly by changing normal anesthesia with 5 mg of Valium (diazepam, Waylis Therapeutics). When that isn’t enough for my sufferers, I administer MKO Soften (ImprimisRx), which incorporates sublingual midazolam, ketamine and ondansetron.
As a result of I take into account retrobulbar blocks too dangerous with out an anesthesiologist, I as a substitute administer lidocaine jelly adopted by a Betadine (povidone-iodine, Atlantis Shopper Healthcare) wash for sub-Tenon blocks and, lastly, a subconjunctival injection of lidocaine across the port websites for much less complicated vitrectomies. This protocol prevents my sufferers from feeling ache or stress.
OBS vitrectomy may be adopted by any retina surgeon, and my colleagues are typically open to the method as soon as they’ve seen it carried out and reviewed the proof.
Securing reimbursement
Surgeons typically ask me if there’s a mechanism for reimbursement for his or her OBS procedures. There’s, and it brings returns which can be typically on par with reimbursement for historically carried out ophthalmic procedures.
Billing the skilled element is easy with industrial insurers, which use the identical procedural codes whatever the website of service.
However, CMS doesn’t have commonplace codes for in-office ophthalmic procedures. Quite, after paying OBS surgeons knowledgeable price, it reimburses physicians for his or her overhead bills by way of a secondary-local reimbursement based mostly on native Medicare Administrative Contractor codes in all 12 native jurisdictions.
Trying forward, CMS is contemplating the institution of ordinary non-facility codes for in-office ophthalmic procedures (Mott).
Garnering assist
I constructed my surgical suite for $100,000, updating a break room with flame-retardant wall insulation, air filtration, an impenetrable flooring, sterile storage and processing areas, and preop and postop areas.
That is attainable for any follow with 500 to 800 sq. toes of obtainable area, and constructing to the requirements of an ASC may be achieved affordably because of the minimal regulatory setting surrounding connected surgical suites. Additionally it is useful that medical gear resembling vitrectomy machines may be paid off over time.
Though facilities can create and run surgical suites on their very own, I’ve discovered it worthwhile to work with iOR Companions, which helps ophthalmology practices develop and handle their OBS areas.
I strongly advise colleagues to do the identical as a result of a educated consulting agency will help safe accreditation and malpractice protection, oversee reimbursement and recordkeeping, and supply steerage in regards to the correct disposal of medicines. As well as, iOR gathers knowledge in regards to the security and efficacy of in-office procedures from the practices in its community and lobbies for essentially the most favorable federal reimbursement protocols.
Altering the way forward for surgical procedure
I’m satisfied that OBS represents the longer term not just for our discipline however for surgical procedure total.
A rising variety of ophthalmologists are proving that extremely complicated, sterile procedures resembling vitrectomy may be achieved safely and comfortably within the workplace with out anesthesiologists, and that’s more likely to encourage an analogous pattern throughout specialties from gastroenterology and normal surgical procedure to ear, nostril and throat.
By bringing these improvements to care supply, OBS will create life-changing alternatives not just for surgeons however for our sufferers who want higher entry to therapy.
For Extra Data:
Omar Shakir, MD, MBA, is a board-certified ophthalmologist and the founding associate of Coastal Eye Surgeons in Greenwich, Connecticut, the place he makes a speciality of cataract and vitreoretinal surgical procedure. Shakir can also be a scientific teacher at Yale College and serves as a principal investigator for a lot of section 2, 3 and 4 scientific trials. He was named the 2025 Operation Sight Volunteer of the 12 months by the ASCRS Basis for offering free or reduced-cost ocular procedures to sufferers in want. He may be reached at omar.shakir@gmail.com.
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Shakir stories being a strategic advisory board member and investor in iOR Companions.
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