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F rom steel blades to iris hooks and pupil expanders to cannulas and phaco tubing, you can get virtually any of the instrumentation your facility needs to perform cataract surgeries in disposable form. But should you? We asked three experts about what factors to consider when it comes to determining whether to sink money into single-use options. acl graft repair
In many situations, the disposable versus reusable debate comes down to two things: The surgeon's personal preference and comfort level with the instrument. This is especially true for ophthalmic blades.
"I like a non-disposable diamond blade because it's the sharpest instrumentation available," says T. Hunter Newsom, MD, a cataract and refractive surgeon and the founder of the Newsom Eye & Laser Center in Sebring and Tampa, Fla. But Dr. Newsom is the outlier in his own practice, where the other surgeons all prefer to use disposable knives.
"They like that the disposable steel blades aren't quite as sharp, so they're more forgiving," says Dr. Newsom. "You can lean a little to the right and it's not going to extend the incision. You can't do that with the diamond blade. You have to go straight in, and straight out."
Durability is an important consideration to keep in mind when deciding between reusable vs. disposable products. Consider the example of iris expansion devices, which cost around $50 for single-use options and $125 to $150 for multi-use versions. If you can use the reusable ones five, six or seven times, your cost per case drops down to $20 to $30, which is less than the cost of the disposable model. But here's where it's critical for surgical facility leaders to understand the skills of their surgeons. "If you have a surgeon who's taking what's supposed to be a multi-use device and consistently getting just one use out of it [due to damage], you're probably going to need to invest in disposables," says Dr. Newsom.
Of course, cost is a major consideration when it comes to disposables. But this isn't as cut-and-dried as it first appears. Diamond blades cost around $3,000 per knife which, of course, is a lot. But then again, Dr. Newsom performs around 3,000 cataract procedures annually, and has invested in 16 diamond blades — a $48,000 investment. Now, compare those costs to disposable steel blades, which can run from $20 per blade on the low end all the way up to $40 to $50 on the very high end. Even assuming your facility is purchasing disposables at the lowest end of that range, it's going to cost you $60,000 to purchase knives for 3,000 cataract cases.
But you can't simply do an apples-to-apples comparison of reusable diamond blades versus disposable steel blades. "When you're comparing the cost of single-use instruments to the cost of disposables, you have to look at cost of labor and the sterilization costs of reprocessing instruments," says Robert S. Bailey, Jr., MD, director of cataract and primary eye care service at Wills Eye Hospital in Philadelphia, Pa. "You may think the cost of disposable instruments is more, but when you factor in labor and sterilization, you may very well find that there are actually some savings there."
You'll also want to consider facility size. If you're a smaller facility, you may be able to dig into your data, determine your surgeon's preference and skill level, and offer the option of either disposable or multi-use items. But if you're a larger, high-volume center, purchasing both types of instruments can be a logistical nightmare, so you're probably better off standardizing to single-use options.
Case volume is also an important consideration. Reusable diamond blades can be extremely economical and maintain their sharpness if you take proper care of them. However, they do break easily. "If you're doing 500 cases a year, and you go through three diamond blades, disposables are going to be a much better option for you," says Dr. Newsom. Conversely, if you're doing 5,000 cases per year and your surgeons excel at maintaining diamond blades, disposables are the costlier option.
Paramount to any decision a facility makes is patient safety. And this is an area in which disposables hold a clear advantage. Without the need to adequately reprocess your instrumentation, you lower the risk of infection and/or post-operative inflammatory problems such as toxic anterior segment syndrome (TASS).
Dr. Bailey says Wills Eye Hospital made the move from multi-use to disposable cannulas about five years. ago. Multi-use cannulas can, over time, rust on the inside and when a surgeon administers an injection, there's the potential for residual material to contaminate the eye, says Dr. Bailey. "[Eliminating that risk] is a clear advantage of disposable cannulas," he adds.
Plus, when you factor in the increased demand for smaller gauge micro-incision cataract instruments, which are extremely difficult to sterilize properly without damage, many facilities see disposables as an obvious choice.
There's still one major con to disposable instruments environmentally conscious administrators simply can't ignore: The green factor. The sheer amount of waste that's generated by cataract surgeries at high-volume facilities is staggering.
"I perform 20 cataracts and see the amount of trash bags that are thrown out at the end of the day, and it's incredible," says Dr. Bailey. "We need to start thinking about the environmental impact and the carbon footprint we're creating after each case."
Of course, when you're tackling a procedure with notoriously thin margins like cataracts, sustainability is unlikely to be your top priority. For most facilities, the question about disposable versus reusable simply comes down to cost, safety and surgeon preference. And for some of the instruments involved in cataract procedures, that question is already being decided for you by the industry.
"Look at reusable phaco tubing," says Dr. Newsom. "Hardly anybody even makes reusable tubing anymore. The industry basically just said, "We're all going disposable now.'"
Perhaps that will be the case with other reusable cataract instruments five or 10 years from now. OSM
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