Office-Based Cataract Surgery Measures Up To ASC Cases

Medscape

20-05-2025

Cataract surgeries performed in a surgery suite in the ophthalmologist's office had significantly lower complication rates than operations performed in an ambulatory surgery center, a study of more than 1300 operations performed by the same surgeon in both settings found.
Joseph Starns
'Our study shows that performing cataract surgery in an office setting does not increase the rate or risk of adverse events,' Joseph Starns, a medical student at the Louisiana State University Health Sciences Center School of Medicine in New Orleans, told Medscape Medical News .
Starns presented results of a retrospective review of 1335 cataract surgeries performed in both an office-based setting and a surgery center on May 7 at Association for Research in Vision and Ophthalmology (ARVO) 2025 Annual Meeting in Salt Lake City.
All the operations were performed by Brendon Sumich, MD, a cornea specialist in New Orleans. The 656 surgeries performed in the office occurred between September 2022 and June 2024; the 679 operations in the surgery center took place from January 2021 through June 2024.
Adverse Event Rates
Seven patients (1%) treated in the office setting experienced an adverse event. These complications included three unplanned vitrectomies (0.46%), two returns to the operating room (0.3%), one referral for retinal complications (0.15%), and one call to 911 (0.15%).
Among patients seen in the surgery center, 22 patients (3%) experienced adverse events. These included one case of endophthalmitis (0.15%), six unplanned vitrectomies (0.88%), nine returns to the operating room (1.33%), five referrals for retinal complications (0.74%), and one event of persistent corneal edema (0.15%).
In the past decade or so, cataract surgeons have been transitioning straightforward operations from surgery centers to the office. Market Scope Ophthalmic Perspectives, a data analytics firm, reported the proportion of office-based cataract procedures rose to 2.2% in 2023, up from 0.5% in 2020. 'We anticipate office-based surgery becoming more popular over the next 5-10 years,' Starns told Medscape Medical News .
Cataract surgery does not require patients to receive an IV or to fast before the operation, and in most cases, they already know both the setting and the support staff, Starns said.
But potential drawbacks can include more difficulty for the operating team to control patient anxiety and the inability to combine the cataract surgery with other procedures, such as minimally invasive glaucoma surgery, he said.
The latter point can potentially skew outcomes, Starns said. 'There may be selection bias, in that anticipated complex surgery may be selectively scheduled' for a surgery center, he acknowledged.
The new study did not look at the cost of having cataract surgery in one setting vs the other, but Starns said office-based procedures are likely more cost-effective because they do not require anesthesia and the fees for these services. Nor does it require preoperative testing or medical clearance examinations from the patient's primary care provider, cardiologist, or other types of providers.
He added that providers do not charge a facility fee for office-based surgery, whereas surgery centers do, which further lowers costs for the office setting. Currently, Medicare does not cover facility fees for office-based procedures, but it does so for surgery centers.
Strengths and Limitations
Starns noted one strength of the study is that one surgeon performed all the procedures. 'That means uniform surgical techniques, patient population, and perioperative care routines,' he said. Both observation groups demonstrated 'significant surgical volume,' he added.
Neal Shorstein, MD
The study population size is another strength, said Neal Shorstein, MD, a retired cataract surgery with Kaiser Permanente in Northern California and an adviser to the Seva Foundation, a nonprofit group that develops eye care programs in underserved regions. 'When you get over 1000 or so, a study of this nature has a little bit more statistical power,' he said.
The evidence comparing the two settings for cataract surgery is limited, he said. However, the new findings agree with results of a 2016 retrospective consecutive case series of 21,505 cataract operations performed in an office setting, Shorstein said.
Clarity on the types of cases performed in the office is needed to better compare those done in a surgery center. 'That's extremely important because their conclusion that office-based surgery was better, with fewer adverse events, raises the question: Was there some sort of conscious or unconscious selection bias of healthier patients for the office-based surgery?' Shorstein said.
The study was independently supported. Starns and Shorstein reported having no relevant financial conflicts of interest.