Transitioning Retina Surgery to Office-Based Settings: A Practice Perspective

Overview

A retina practice successfully transitioned urgent and elective retina surgeries from hospital and ASC operating rooms to an office-based surgical suite, improving patient access and workflow. Since May 2022, hundreds of procedures have been safely performed in-office, demonstrating that many vitreoretinal surgeries can be effectively managed outside traditional surgical centers.

Background

Retina surgeries traditionally require hospital or ambulatory surgery center (ASC) operating rooms, often leading to scheduling delays, especially for urgent cases like retinal detachments. Advances in small-gauge instrumentation, vitrectomy cutters, and visualization systems have made retina procedures less invasive and more efficient, enabling a shift toward outpatient and office-based surgery (OBS). Cataract surgery has paved the way for office-based procedures, and retina surgery is now following this trajectory. The practice explored OBS to address emergent care gaps and improve surgical access and patient experience.

Data Highlights

Since launching the office-based surgical suite in May 2022, the practice has completed hundreds of retina procedures, including pars plana vitrectomies for retinal detachment, dropped lens removals, secondary intraocular lens placements, epiretinal membrane and macular hole repairs, silicone oil removals, intraocular implant procedures, and selected scleral buckle surgeries. Pain scores comparing OBS patients (without IV sedation) to those in ASCs (with IV sedation) were comparable, supporting the safety and efficacy of the office anesthesia protocol.

Key Findings

• Office-based surgery (OBS) improved patient access by eliminating scheduling bottlenecks and enabling same-day procedures.
• Many vitreoretinal surgeries, including urgent retinal detachments, can be safely and efficiently performed in the office setting with proper patient selection.
• Careful patient selection excludes those with significant systemic conditions or requiring general anesthesia, focusing on medically stable patients comfortable with local or oral anesthesia.
• Anesthesia management relies on local subconjunctival and sub-Tenon’s anesthesia with oral anxiolytics as needed, avoiding IV sedation and retrobulbar injections.
• OBS suites require dedicated sterile environments, appropriate accreditation, customized equipment, and trained staff, often leveraging existing personnel with additional training.
• Staff enthusiasm for new surgical roles has enhanced practice culture and recruitment.

Clinical Implications

Office-based retina surgery offers a practical solution to overcome OR access challenges, particularly for urgent cases where timely intervention is critical to preserving vision. Implementing OBS requires careful patient selection, adherence to accreditation standards, and staff training but can lead to improved workflow, patient satisfaction, and cost efficiencies. Clinicians should consider OBS as a viable option for appropriate vitreoretinal procedures to enhance care delivery.

Conclusion

Transitioning retina surgery into the office setting is feasible, safe, and beneficial for both patients and providers when supported by appropriate protocols, infrastructure, and team engagement. This approach represents a significant advancement in delivering timely, patient-centered retinal care.

References

1. Bringing Retina Surgery Into the Office, Retina Today, 2023