GLAUCOMA EWAP SEPTEMBER 2022 51 thing is they get to spend time in the operating room with surgeons and they often have a lot of experience to share. So talking with representatives about complications, how to handle problems, even in some cases how to handle billing and coding, all of these conversations are beneficial. Dr. Okeke: When it comes to adopting a new glaucoma treatment, sometimes I may be involved with clinical trials and have the ability to get some experience with it, which can make it easier to adopt when it comes out commercially. There are instances where I may want to adopt a new technology earlier, but I might be stalled due to poor insurance coverage or limitations for various reasons in my current practice. There are also times when I’m not yet sold on where I can see the new technology fitting in my practice. The easier I can see a new glaucoma treatment fitting in my practice, the earlier I am to adopt it. If I have interest in adopting a device, there are a series of steps in the onboarding process. Before even getting the chance to learn the technique and master it over time, the device will need to be vetted for insurance coverage. There will be a short trial of a few patients to confirm coverage with everyone on board from the clinic staff to the surgical staff to the medical/surgical device representative all set on a specific start date. If [a device is] something that I think will be great for my patient population, the sooner I get access to it the better, but sometimes there is a device that I might have had access to through clinical trials/ research, so I might be ready to adopt it right away. Insurance coverage can be a limiting factor for early adoption as well. EyeWorld: How does training/ learning curve affect bringing in a new treatment option? Dr. Radcliffe: The procedures that are more straightforward and have a shorter learning curve will be adopted more quickly. Some of the treatments that require more patients and nuance can be valuable for doctors and can often pay off when newer procedures come around. I think when it comes to MIGS, learning all the different approaches makes it easier when newer approaches come out because they all share certain characteristics. As we all know with MIGS, the most important skill you can acquire is to have excellent visualization, so if you’ve been doing some sort of complicated MIGS, it’s likely you’ve gotten good at gonioscopy. Having learned that skill will shorten every other learning curve you have in your career. Dr. Okeke: If I’m eager about the device, the training process will not be a deterrent. I welcome a well thought out training program with video instruction, wet labs, and live surgical trainer instruction. It always helps to make the process smoother for me. EyeWorld: Is staffing a consideration? Dr. Radcliffe: For the most part, MIGS today require very little help from our technical staff. But there have been some in the past where staff have to play a more active role, and I do think having more than one person in the OR who needs to be knowledgeable does limit this technology. Dr. Okeke: If more staff training is required in order to bring in a new technology, that can be a rate limiting step. Given staff shortages recently, we need to make sure the practice is running well and patients are being taken care of, so heavy staff training requirements may delay the start date of new technology. EyeWorld: Does patient preference ever drive adopting a new treatment option? Dr. Radcliffe: In terms of patient preferences on these treatments, The XEN Gel Stent has been marked at the tip and is implanted under the conjunctiva with the ab interno approach. Source (all): Constance Okeke, MD
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