Outpatient Surgery Magazine - Subscribers

2018 Salary Survey - Outpatient Surgery Magazine - January 2019

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 108 of 124

and effective surgery. Here's a rundown. Mydriatic agents Pharmaceutical options for maintaining pupil dilation do not involve the mechanical manipulation of the iris, so there's less risk of cystoid macular edema developing after surgery, says Rex Hamilton, MD, MS, FACS, a cataract and refractive surgeon at Santa Monica (Calif.) Eye Medical Group. Dr. Hamilton says most surgeons routinely use topical or intracameral agents to create intraoperative mydriasis, but differ in their drugs of choice. He typically injects Shugarcaine (a lidocaine-epinephrine com- pound) to keep pupils dilated. Lidocaine provides anesthetic comfort and also paralyzes the pupil's sphincter muscle, causing the pupil to open wide, says Kevin Miller, MD, chief of the cataract and refractive surgery division at the David Geffen School of Medicine at UCLA. Shugarcaine stimulates the pupil's dilator muscle, which also helps to maintain pupil dilation, he adds. Surgeons also commonly opt for tropicamide and phenylephrine or a longer-lasting agent such as cyclopentolate, says Dr. Miller, adding that NSAIDs are an underappreciated option for helping to maintain pupil dilation. "That's where Omidria comes into play," he says. Omidria, the intraocular irrigating solution that's administered through balanced saline solution during surgery, contains the NSAID ketorolac and the dilating agent phenylephrine. It's indicated and FDA-approved to maintain pupil dilation and improve post-op healing, but it's also an expensive drug (about $465 per 4-ml vial) in a specialty with razor-thin margins. However, the cost concern was mitigated when CMS decided last October to reinstate Omidria's pass-through status until Oct. 1, 2020. That means you can bill CMS separately for J A N U A R Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 1 0 9

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