Welcome to Interventional Mindset

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9 min read

Drs. Gupta, Wörtz, and Radcliffe discuss what it means to have an interventional mindset as an ophthalmologist.

Based on the clinical experiences of cataract and refractive surgeons, Interventional Mindset is a new initiative for ophthalmologists, featuring the expertise from leaders across ophthalmology.
Interventional Mindset features three focus areas: glaucoma, ocular surface disease, and refractive cataract surgery. All three spheres overlap, aiding in the process of providing meaningful treatments to patients based on a holistic understanding of their ocular health.

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.

What is the purpose of Interventional Mindset?

The field of ophthalmology offers surgeons a wide variety of specialized procedures and access to a never ending supply of innovative technology. Dr. Gupta noted that there are such frequent updates in surgical procedures and technological advancements that staying on top of these developments requires a concerted effort. Further, integrating these procedures into clinical practice is not always straightforward.
The goal of Interventional Mindset is to provide clinicians and surgeons with actionable information on how to implement new technologies into their day-to-day operations.

Understanding the barriers and obstacles that MDs face

When implementing new services, surgeons may feel pressure to perfectly perform the procedure right from the start, which can cause anxiety that prevents them from pursuing interventional therapies. Dr. Gupta stated that when adopting a new technology it’s helpful to have someone like a mentor available to troubleshoot any problems and guide the process of mastering the learning curve for a new procedure.
When she started implementing new therapies, she found that receiving guidance in how to navigate initial patient conversations around, for example, self-pay treatments, helped her build confidence in the procedure, and communicate that confidence with patients more clearly.
Patients can sense when surgeons believe in the procedure that they recommend and the perceived value of a strong clinical recommendation is not to be underestimated.
This issue of confidence is true across ophthalmology subspecialties. Dr. Wörtz is aligned with Dr Gupta, remarking that over time you realize the benefits of the treatment and that enthusiasm is contagious, so eventually patients will be more receptive to upgrading their treatments. A key component of implementing new technologies is ensuring that all supporting elements in your practice (i.e., staff, office environment, equipment, etc.) are as strong and up-to-date as possible. Dr. Radcliffe maintained that being confident in your practice’s foundation bolsters the results of any new technology or service added, because it will only enhance the already solid foundation.

Discussing out-of-pocket costs with patients

Initially, Dr. Gupta felt nervous talking to patients about treatments that were not fully covered by insurance because she worried that when patients paid out-of-pocket, it was acceptable for their expectations to go through the roof. With the thought of unrealistic patient expectations came even more worries around delivering to their level of expectations, which if not reached,  could be considered a failed procedure.
Ultimately, she came to realize that a crucial part of the process was setting realistic expectations for the patient by outlining what to expect from the treatment and its limitations. This allows the patient to make informed evidence-based decisions, thereby preventing surgeons from having to take on the extra weight of any unrealistic expectations from the patient.
Dr. Gupta conveyed that clinicians should keep in mind that pursuing the most beneficial treatment is in the patient’s best interest to potentially maximize the outcome. If you believe in the technology, it can be advised that the patient conversation speaks to the value proposition based on their needs rather than the cost of the procedure. She noticed a shift in her practice when she stopped fixating on the price of the service and instead focused on educating the patient to let them make an informed decision, as opposed to deciding for them with selective introductions to the technology.
Empowering the patient to make that decision made Dr. Gupta more comfortable in making the professional recommendation.

Viewing glaucoma management with an International Mindset

As a glaucoma and cataract specialist, Dr. Radcliffe discussed the impact of innovations in microinvasive glaucoma surgery (MIGS). With the broad array of devices and procedures offered, he highlighted that what works well for some surgeons won’t for others. It’s important that surgeons assess and understand their own skill set to hone in on their individual specialization.
He also noted that leveraging partnerships with industry partners can be very helpful when integrating new technologies into your practice because they can offer educational and peer-to-peer resources about the various MIGS devices and respective techniques. Case in point, if you have finished training and are not in an academic setting, you will have to learn how to use the MIGS devices by either watching other surgeons perform the procedure, having colleagues train you, or relying on industry partners for training videos and white papers. It can be helpful to reach out to representatives to get data on the efficacy of various MIGS devices to familiarize yourself with their safety profiles. You can also present this data to patients, which assists in instilling confidence in the decision-making process when electing to proceed with MIGS or other surgical procedures.
Prior to adopting a new MIGS device, it’s valuable to review if the practice is more broadly well-equipped to detect and diagnose glaucoma, as it can be a difficult condition to “dabble” in. Dr. Radcliffe observed that many new glaucoma diagnoses occur during cataract evaluations. Thus, as a surgeon, you bring in a patient because you want to address the cataract, but if you are experienced in performing MIGS procedures, you can also do optical coherence tomography (OCT) imaging to assess the anterior chamber angle and potentially add on a MIGS procedure to improve the patient’s outflow system.

Having an Interventional Mindset means a lifetime of learning

Dr. Wörtz remarked that when in residency, many procedural habits from a surgeon’s training are based on what they learned from their mentors. However, once you start practicing, there is less of a clear infrastructure outlined for how ophthalmologists can continue to evolve and develop their skill set. While ophthalmology organizations provide educational resources such as skill transfer courses, wet labs, etc., it can be difficult to integrate a new technology into your practice when you don’t have a mentor guiding the process.
With Interventional Mindset, the goal is to chip away at some of those barriers that ophthalmologists face when starting a new procedure or technology and provide pearls for  navigating these new waters. The hope is to shorten the learning curve for surgeons across subspecialties, as the series features wisdom from experts in the field that can provide some guidance during the early stages of adopting a new service.
Additionally, there is a fair amount of interplay and overlap between ocular surface disease, refractive cataract surgery, and glaucoma. Similar to the wide variety of offerings for MIGS, Dr. Gupta noted that there are many meibomian gland dysfunction (MGD) in-office procedures, so clinicians will likely feel similarly about sorting through new technologies and deciding what to integrate into your practice to continue to grow as a surgeon.

Final thoughts on Interventional Mindset

Dr. Wörtz concluded that, in reality, no doctor is perfect, and when adopting a new technology you’ll often encounter bumps in the road. One of the biggest barriers that prevents people from trying new things is the fear of failure and needing more support.
By featuring experts across ophthalmology subspecialties having an open dialogue on this process, the goal of Interventional Mindset is to make it feel less intimidating for surgeons to explore the latest surgical techniques and devices available, discussing the merits of new diagnostic or point-of-care systems, and learn more about novel therapeutics on the horizon.

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
Nathan Radcliffe, MD
About Nathan Radcliffe, MD

Nathan M. Radcliffe, M.D. is a highly-experienced glaucoma and cataract surgeon.

Dr. Radcliffe graduated Alpha Omega Alpha from the Temple University School of Medicine and was named transitional resident of the year at the University of Hawaii in Honolulu. He was Chief Resident at New York University for his ophthalmology residency and Chief Glaucoma Fellow at the New York Eye and Ear Infirmary.

He was the Director of the Glaucoma Services at NYU and Bellevue hospital and currently, is part of the advanced Microincisional Glaucoma Surgery Center at New York Eye and Ear Infirmary. Dr. Radcliffe is unique because he is active in both academic and private practice settings. He is a microincisional glaucoma surgery (MIGS) innovator and instructor and has given lectures all over the United States.

Dr. Radcliffe was the first surgeon in New York to offer patients the CyPass Supraciliary Microstent, the Kahook Dual Blade Goniotomy, Visco 360 and Trab 360, the G6 micropulse laser, and Allergan’s Xen subconjunctival implant.

Dr. Radcliffe has managed some of the most difficult glaucoma and cataract cases from all over the world and is truly able to offer a tailored glaucoma and cataract surgery to his patients, being able to perform all of the available glaucoma surgeries that are currently FDA approved, and knowing the procedures and the efficacy and safety data well enough to correlate the optimal procedure with the patient’s disease.

Nathan Radcliffe, MD
Gary Wörtz, MD
About Gary Wörtz, MD

Gary Wörtz, MD is a board-certified ophthalmologist from Lexington, KY specializing in cataract and refractive surgery.

Since completing his training in 2008, Dr. Wörtz has successfully performed thousands of cataract and laser procedures. He currently practices in Lexington at Commonwealth Eye Surgery. Dr. Wörtz became one of the first surgeons in Kentucky to perform laser refractive cataract surgery. He utilizes the latest technology both in and out of the operating room to help restore vision for cataract patients.

Dr. Wörtz enjoys innovation and teaching his techniques to others around the country. He has been a consulting speaker for Alcon, AMO, Bio-Tissue, TearLab, Carl Zeiss Meditech and Dialogue Medical. He has also been a principal investigator in multiple FDA pharmaceutical trials in the ophthalmic sector. He has given numerous lectures at both the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgeons annual meetings. He is also a frequent contributor to many trade journals such Cataract and Refractive Surgery Today, MillennialEye, Ophthalmology Times, and EyeWorld, and was recently named to the editorial board of Ocular Surgery News.

Gary Wörtz, MD
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