Cataract Surgery Shifts to the Office: New Study Highlights Success of Minimal Sedation

ORLANDO, FL – October 18, 2025 – A groundbreaking new study is challenging the traditional landscape of cataract surgery, demonstrating that the procedure can be safely and effectively performed in office-based suites with minimal oral sedation, eliminating the need for hospital or ambulatory surgery center visits and intravenous (IV) sedation for the vast majority of patients. The findings, presented today at the 129th annual meeting of the American Academy of Ophthalmology, suggest a significant shift towards greater convenience and comfort for patients undergoing this common vision-restoring surgery.

Led by Brad H. Feldman, MD, of Philadelphia Eye Associates and Wills Eye Hospital, the prospective study analyzed all patients undergoing cataract surgery with oral sedation in a dedicated office-based suite. Researchers where surprised to find that only 10% of patients required supplemental sedation beyond a standard dose of diazepam (5mg for older patients, 10mg for younger). Notably, no patient scheduled for office-based surgery needed to be transferred to a hospital or surgery center for IV sedation due to anxiety or restlessness.

“We anticipated needing higher levels of oral sedation,” Dr. Feldman stated. “The results exceeded our expectations.” Further bolstering the study’s conclusions, over 99% of patients opted to have their second eye operated on in the office setting, even with a nearby ambulatory surgery center readily available.

This research fills a critical gap in existing literature. While previous large-scale studies have confirmed the safety of office-based cataract surgery – including work from Kaiser Permanente and a 36-practise study led by lance J. Kugler – detailed data on specific oral sedation protocols in private practice settings has been limited. Dr. feldman estimates over 100 private practices across the US are now performing office-based cataract surgery, primarily utilizing oral sedation.

“We wanted to share our center’s specific approach to help other ophthalmologists considering this transition,” he explained.

The office-based suites are not simply repurposed exam rooms. Dr. feldman’s facility is accredited by The Joint commission and built to rigorous standards mirroring those of ambulatory surgery centers, featuring specialized operating rooms, sterile processing areas, advanced air filtration, and dedicated electrical systems.

A key advantage of the oral sedation approach lies in its timing. Diazepam’s effects align with pupillary dilation from eye drops, allowing surgeons to assess both pupil response and sedation levels before entering the operating room. Supplemental sedation, when needed, can be administered quickly via an orally dissolving tablet containing midazolam, ketamine, and ondansetron.

“Unlike IV sedation,we don’t bring patients into the operating room until they are adequately sedated,” Dr. Feldman emphasized, “making sedation levels during surgery highly predictable.”

The team’s positive experience was rapid. “By my second day in the office-based suite, I felt confident this setting was better for most patients in terms of comfort, convenience, and safety,” Dr. Feldman added.

The research team continues to collect data and encourages other surgeons to share their experiences as office-based cataract surgery gains momentum. Instruction courses on the topic were also offered at this week’s American Academy of Ophthalmology annual meeting, signaling a growing interest in this evolving surgical approach.

How will advancements in AI and machine learning impact the precision and personalization of IOL selection and surgical planning?

Advancements in Cataract Surgery: expectations for Future Innovations and Shifts to Office-Based Procedures

The evolution of Cataract Surgical Techniques

Cataract surgery has undergone a remarkable transformation in recent decades. What was onc a lengthy hospital stay is now frequently an outpatient procedure with rapid visual recovery. This progress is driven by continuous innovation in both technology and surgical approaches. Traditional cataract surgery involved a large incision, requiring sutures and a prolonged healing period. Today, phacoemulsification, utilizing ultrasound energy to break up the clouded lens, is the gold standard.

Though, the evolution doesn’t stop there. We’re seeing exciting developments that promise even greater precision,safety,and convenience for patients. Key areas of advancement include:

* Femtosecond Laser-Assisted Cataract Surgery (FLACS): This technology uses a laser to automate several steps traditionally performed manually, such as corneal incisions, capsulotomy (creating an opening in the lens capsule), and lens fragmentation.

* Advanced Intraocular Lenses (IOLs): Beyond monofocal IOLs that correct vision at a single distance, we now have multifocal, extended depth of focus (EDOF), and toric IOLs to address astigmatism and provide a wider range of clear vision.

* Micro-Incision Cataract Surgery (MICS): Refining phacoemulsification techniques to utilize even smaller incisions, leading to faster healing and reduced astigmatism.

* Artificial Intelligence (AI) and Machine learning: Emerging applications in surgical planning, intraoperative guidance, and post-operative monitoring.

The Rise of Office-Based Cataract Surgery (OBCS)

A significant shift in cataract surgery delivery is the growing trend towards office-based cataract surgery (OBCS). Historically, cataract surgery was almost exclusively performed in hospital operating rooms or ambulatory surgery centers (ASCs). OBCS brings the procedure directly to a physician’s office equipped with a dedicated surgical suite.

Benefits of Office-Based Cataract Surgery:

* Increased Convenience: Eliminates the need for patients to travel to and navigate a hospital or ASC.

* Reduced Costs: Potentially lower facility fees compared to traditional settings.

* Enhanced patient Comfort: A more relaxed and familiar environment.

* Greater Physician Control: Surgeons have complete control over the surgical setting and schedule.

Though, OBCS requires meticulous planning and adherence to stringent safety standards. Proper accreditation, qualified staff, and robust emergency protocols are essential. The suitability of a patient for OBCS is resolute by a thorough pre-operative evaluation, considering factors like overall health, complexity of the cataract, and the need for anesthesia.

Future Innovations on the Horizon

The future of cataract surgery is bright, with several promising innovations poised to further revolutionize the field.

1. Enhanced Imaging Technologies

* Optical Coherence Tomography (OCT): Real-time, high-resolution imaging of the eye during surgery, providing surgeons with detailed data about the lens, capsule, and surrounding structures. This allows for more precise surgical planning and execution.

* Heidelberg Spectralis OCT: Advanced OCT systems offering improved image quality and faster scanning speeds.

* Digital pathology Integration: Combining OCT data with digital pathology analysis for a more comprehensive understanding of the cataract and its impact on the eye.

2. Next-Generation Intraocular Lenses

* light-Adjustable Lenses (lals): These iols can be adjusted after implantation using ultraviolet light, allowing for fine-tuning of vision to achieve optimal results. This is particularly beneficial for patients who have had previous refractive surgery or have complex visual needs.

* Accommodating IOLs: Designed to mimic the natural focusing ability of the eye, providing clear vision at multiple distances. Ongoing research focuses on improving the range and smoothness of accommodation.

* Drug-Eluting IOLs: IOLs coated with medications to prevent post-operative inflammation and posterior capsule opacification (PCO),reducing the need for additional procedures.

3. Robotic-Assisted Cataract Surgery

While still in its early stages, robotic-assisted cataract surgery holds immense potential. Robotic systems can offer:

* Enhanced Precision: Robots can perform movements with greater accuracy and stability than human hands.

* Reduced Surgeon Fatigue: Robotic assistance can alleviate the physical strain on surgeons during long procedures.

* Remote Surgery Capabilities: Potentially enabling surgeons to perform procedures remotely, expanding access to specialized care.

4. Personalized Cataract Surgery

The future will see a move towards truly personalized cataract surgery, tailored to each patient’s unique anatomy, lifestyle, and visual goals. This will involve:

* Advanced Biometry: Precise measurements of the eye to determine the optimal IOL power and type. Technologies like swept-source OCT biometry are becoming increasingly common.

* Predictive Analytics: Using AI and machine learning to predict surgical outcomes and optimize treatment plans.

* Genetic Testing: identifying genetic factors that may influence cataract growth and response to treatment.

Addressing Patient concerns & Expectations

Patients considering cataract surgery today are more informed and have higher expectations than