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N O V E M B E R 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
advances is wide-field
visualization. We can
see a lot more periph-
eral tissue and do a
lot more peripheral
dissection. I now do
all of my cases using
3D glasses and a flat-
screen display with
3D images: heads-up
3D surgery. I get a digitalized picture I can manipulate in any num-
ber of ways. As the technology advances, we're also on the
precipice of having multimodal heads-up visualization, so we won't
have to look into a microscope.
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Understand and manage costs. It's easy to
see the start-up costs with retina as daunting. You need
lasers, you need cryotherapy, you need a vitrectomy
machine, you need gas, you need instruments and so forth. Even if
you're already doing cataract surgery, the equipment needed for vit-
rectomy is entirely different. To equip an OR for retina, the cost is
at minimum $500,000.
It's definitely significant, but in a well-run facility, the overall over-
head for equipment and disposables — which I've calculated now for
many years — should turn out to be less than 20% of the total over-
head. The No. 1 expense? Personnel. It's vitally important that every-
one on the staff is used in the appropriate place — that you have
skilled staff doing skilled work, not simple tasks. For instance, you
don't want to have an RN turning a knob on a laser at your verbal
command when you can control it with a foot pedal. When you under-
O P H T H A L M O L O G Y
Pravin
Dugel,
MD
PERSONNEL DISCIPLINE
Since staff is the most significant
expense, skilled personnel should
be doing skilled work only.
