How to Transition to Office-Based Ophthalmic Surgery

This is editorially independent content
9 min read

Join Drs. Preeya K. Gupta, MD, and Jonathan D. Solomon, MD, in their discussion on how ophthalmologists can transition to office-based ophthalmic surgery.

In this episode of Interventional Mindset, Preeya K. Gupta, MD, and Jonathan D. Solomon, MD, explore the benefits and nuances of in-office ophthalmic surgery.
Currently, the majority of cataract surgeries are outpatient procedures, suggesting the potential to shift the treatment paradigm for uncomplicated cataract surgeries from an ambulatory surgery center (ASC) to an office-based setting.1
Drs. Solomon and Gupta discuss their experiences with transitioning to office-based ophthalmic surgery and pearls for clinicians interested in being at the forefront of medical advancements and patient care.

Interventional Mindset is an educational series that gives eye physicians the needed knowledge, edge, and confidence in mastering new technology to grow their practices and provide the highest level of patient care. Our focus is to reduce frustrations associated with adopting new technology by building confidence in your skills to drive transformation.

Browse through our videos on a variety of topics within cataract and refractive surgery, glaucoma, and ocular surface disease to learn practical insights into adopting a variety of new surgical techniques and technology.

Improving access to ophthalmic surgery with office-based procedures

Dr. Solomon’s decision to transition to office-based ophthalmic surgery stemmed from obstacles he experienced relying on ASCs, especially as his practice grew across state lines (i.e., requiring accommodations for states with certificate of need [CON] laws) and demanded greater surgical volume.
In contrast, after leaving an academic center, Dr. Gupta remarked that the impetus to transition to an in-office model for ophthalmic surgery was to fill open time in the clinic and offer a tailored experience for her patients, specifically for refractive and cataract surgery patients.
She emphasized that not all patients may be a good fit for office-based cataract surgery, so having access to both ASC and in-office facilities can be beneficial to ensure that patients with different needs receive appropriate treatment.

Office-based cataract surgery can help doctors:

  • With a need for more operating room (OR) time or flexibility in scheduling due to a rapidly growing patient base
  • Navigating different requirements between CON state laws
  • Interested in controlling the entire surgical process to tailor and optimize the patient experience

Key considerations for office-based cataract surgery

Drs. Gupta and Solomon highlighted four key elements to factor into deliberations around integrating office-based ophthalmic surgery into a clinical practice setting:
  1. Patient base
  2. Insurance reimbursement
  3. Office space and staff training
  4. Accreditation

1. Patient base

When considering whether adopting office-based cataract surgery is a practical next step for your ophthalmology practice, Dr. Solomon recommended first examining the patient base.
Practices in which a significant portion of the surgical volume centers around refractive lens-based procedures, such as phakic intraocular lens (IOL) implantations, refractive lens exchange (RLE), and clear lens extraction, are likely strong candidates for office-based surgery.
This patient population has optimal candidates for refractive cataract surgery performed in the office itself, he added, because they are individuals who have shown an interest in self-pay procedures and are not necessarily relying on a third-party payer.

2. Insurance reimbursement

A notable issue clinicians tend to face in this process relates to insurance reimbursement. Dr. Solomon noted that doctors can partner with companies like iOR Partners that offer consultation, development, and management tools to provide billing assistance and perform insurance pre-authorization.
However, there are many different approaches to office-based ophthalmic surgery, explained Dr. Gupta. Clinicians would benefit from comparing what different pathways and partnerships can be offered in regard to charging for procedures and reimbursement, such as facility fees (which Medicare only covers for surgery done in hospital- or ASC-based surgeries),2 surgeon fees, out-of-network (OON) costs, and self-pay elective procedures.
Particularly in regard to the payer landscape, with time and broader adoption, she expressed hope for more standardization and regulations that clinicians can use as guidance when building out their in-office ORs to get the appropriate facility and surgeon fees.

3. Office space and staff training

At Dr. Gupta’s practice, they predominantly perform refractive and refractive cataract procedures. Consequently, she considered which specific equipment she needed in the surgical suite during the procedure to determine the opportunity and return on investment (ROI) cost of using that space for office-based surgeries.
She noted that office-based ORs can transition to a multifunctional space on days with no office-based surgeries with minimal changes. It could be repurposed for oculoplastic cosmetic procedures, for example.
Dr. Solomon discussed how cross-training laser surgery staff to assist with office-based cataract surgery was a critical component to succeeding with office-based surgeries as there is a common skill set. Additionally, transitioning to an in-office model helped to create a continuity of care for the staff and develop a sense of responsibility for patients as they handled their cases from pre- to post-op.

4. Accreditation

It is essential to understand the added responsibility that comes with managing and maintaining an in-office OR, expressed Dr. Gupta. In an ASC, surgeons can walk in, perform the procedure, and walk out because there is less personal responsibility in operating the facility.
She added that her office is certified by The Joint Commission, meaning the practice adheres to the rules, regulations, and documentation required by this accrediting body. There are other certification organizations that doctors can rely on, but it is not an insignificant task to take on in addition to managing a practice and treating patients.
Of note, office-based surgical suites have different accreditation criteria,1 but are accredited by the same national organizations as ASCs and hospitals, including:3
Seeking approval from healthcare organizations like The Joint Commission helped Dr. Gupta to establish a level of credibility and trustworthiness in their attention to safety protocols along with enhanced quality of patient care. Further, most insurances require that practices have one of four different types of certifications, making it a necessary step in the process for her.

Studies comparing the safety of office-based and ASC ophthalmic surgeries

For clinicians with safety concerns around in-office cataract surgery, recent studies have demonstrated their efficacy and safety.
A 2023 study analyzed the case records of 18,005 cases of office-based cataract or refractive lens surgery performed across 36 clinical sites.4 The rates of post-operative endophthalmitis, toxic anterior segment syndrome (TASS), and corneal edema were 0.028%, 0.022%, and 0.027%, respectively.
Further, unplanned anterior vitrectomy was performed on 0.177% of patients, and while 0.067% of patients needed to return to the OR, 0.011% were referred to a hospital. Investigators reported that the events for office-based cataract or refractive lens surgery were similar to or less than the reported adverse event rate for cataract surgery performed in an ASC.4
In addition, a 2016 study of 21,501 eyes that underwent phacoemulsification demonstrated the safety and efficacy of office-based cataract surgeries performed in minor procedure rooms.5 The study authors reported no cases of endophthalmitis, and there were no life- or vision-threatening intra- or peri-operative adverse events.
Intra-operative ocular adverse events included 119 (0.55%) cases of capsular tear and 73 (0.34%) cases of vitreous loss. Post-operative adverse events included iritis (1.53%), corneal edema (0.53%), and retinal tear or detachment (0.14%).
The research team found that “office-based efficacy outcomes were consistently excellent, with a safety profile expected of minimally invasive cataract procedures performed in ASCs with hospital outpatient departments.”5


Dr. Solomon noted that he has learned a lot from moving from an ASC to an office-based surgery model in regard to specific standards, such as shifting the modality for administering anesthesia during cataract surgery. With this new understanding, he can share this information with colleagues to adapt and improve old protocols—the cornerstone of disruptive technology.
To close the discussion, Dr. Gupta emphasized that clinicians interested in pursuing office-based ophthalmic surgery should “do their homework” to know who can help in the process to learn about the necessary certifications for staff and the practice, assess the potential patient population and volume, and ultimately determine whether it is a viable model for their practice setting.
While a learning curve exists, it is exciting to be at the forefront of medical innovation.
  1. Stephenson M. An update on office-based surgery. Review of Ophthalmology. Published August 10, 2023. Accessed January 12, 2024.
  2. Durrie DS. Office-based surgery vs. ASC surgery. Ophthalmology Management. Published November 2020. Accessed January 12, 2024.
  3. Ambulatory Surgery Center Association. Accrediting Organizations. Ambulatory Surgery Center Association. Accessed January 22, 2024.
  4. Kugler LJ, Kapeles MJ, Durrie DS. Safety of office-based lens surgery: U.S. multicenter study. J Cataract Refract Surg. 2023;49(9):907-911.
  5. Ianchulev T, Litoff D, Ellinger D, et al. Office-based cataract surgery. Ophthalmology. 2016;123(4):723-728.
Preeya K. Gupta, MD
About Preeya K. Gupta, MD

Dr. Gupta earned her medical degree at Northwestern University’s Feinberg School of Medicine in Chicago, and graduated with Alpha Omega Alpha honors. She fulfilled her residency in ophthalmology at Duke University Eye Center in Durham, North Carolina, where she earned the K. Alexander Dastgheib Surgical Excellence Award, and then completed a fellowship in Cornea and Refractive Surgery at Minnesota Eye Consultants in Minneapolis. She served on the faculty at Duke University Eye Center in Durham, North Carolina as a Tenured Associate Professor of Ophthalmology from 2011-2021.

Dr. Gupta has authored many articles in the peer-reviewed literature and serves as an invited reviewer to journals such as Ophthalmology, American Journal of Ophthalmology, and Journal of Refractive Surgery. She has also written several book chapters about corneal disease and ophthalmic surgery, as well as served as an editor of the well-known series, Curbside Consultation in Cataract Surgery. She also holds several editorial board positions.

Dr. Gupta serves as an elected member of the American Society of Cataract and Refractive Surgery (ASCRS) Refractive Surgery clinical committee, and is also is the Past-President of the Vanguard Ophthalmology Society. She gives presentations both nationally and internationally, and has been awarded the National Millennial Eye Outstanding Female in Ophthalmology Award, American Academy of Ophthalmology (AAO) Achievement Award, and selected to the Ophthalmologist Power List.

Preeya K. Gupta, MD
Jonathan D. Solomon, MD
About Jonathan D. Solomon, MD

Dr. Jonathan Solomon is a board-certified ophthalmologist specializing in laser cataract and refractive surgery. He is well known for his activity in the ophthalmic academic community, as well as for his spirit and compassion, which extend beyond the surgical theater.

Dr. Solomon has been acknowledged by GQ Magazine in their “Men of the Year” issue, recognized nationally as one of the “Top Doctors in America” by his peers, and listed as one of Baltimore-Washington’s Super Doctors for 2013.

He works closely with the leading manufacturers of precision surgical equipment, including instruments and intraocular lens implants, and engages in a variety of studies. Some noteworthy studies include the FDA evaluation of accelerated corneal collagen cross-linking for the treatment of keratoconuscorneal ectasia, and the Visian Toric Phakic Intraocular Lens.

Solomon Eye Physicians & Surgeons is also proud to participate in the refinement of LENSAR LASER's STREAMLINE IV/Ally for laser refractive cataract surgery, which allows us to offer patients a more precise, custom procedure as unique to our practice as your eyes are to you.

As the Chief of Ophthalmology at the University of Maryland, Capital Regional Surgery Center and co-founder of the Bowie Vision Institute for Applied Studies, Dr. Solomon continues to educate and train the next generation of refractive and corneal reconstructive surgeons and a fellowship preceptor for the UMD School of Medicine, Department of Ophthalmology & Visual Sciences.

Dr. Solomon proudly offers and pioneered the application of the Callisto Guidance, which allows for Virtually Augmented-assisted feedback in the operating theatre. Dr. Solomon also uses 3D Surgical Guidance, the only one of its kind in the DMV, which ensures precise refractive outcomes for all of the FDA-approved presbyopia-correcting intraocular lenses (IOL): PanOptix, Vivity, Eyhance, Synergy, Tecnis Multifocal, and the RxSight Light Adjustable Lens.

Additionally, to correct astigmatism, the implantation of a wide variety of toric lenses is available to his patients. For Dr. Solomon's highly myopic patients, those who do not qualify for LASIK or PRK, he is a key opinion leader for the implantation of Visian ICLs, which are surgically implanted contact lenses that can give refractive correction and spectacle/contact lens freedom.

Dr. Solomon is an active contributor to the ophthalmic community as a member and leader in multiple professional societies and other organizations.

These include:

  • Medical director of Dimensions Surgery Center
  • Co-founder of the Bowie Vision Institute
  • Fellow of the American Academy of Ophthalmology
  • Fellow of the American Society of Cataract and Refractive Surgery
  • Fellow of the International Society of Refractive Surgeons
  • Executive board member of the Maryland Society of Eye Physicians and Surgeons
  • Official Terps LASIK surgeon at the University of Maryland
  • Founding member of the American-European Congress of Ophthalmic Surgeons
  • Accreditation Board member of the Cornea Society
  • Active consultant to the FDA's Ophthalmic Device Panel
  • Former Clinical Instructor at the Wilmer Eye Institute at Johns Hopkins University

Hospital privileges:

  • Reston Hospital
  • Northern Virginia Eye Surgery Center
  • Fairfax Surgical Center
Jonathan D. Solomon, MD
How would you rate the quality of this content?