Early User Experience with Visante OCT                    for the Anterior Segment                      8 Shareef Mahdavi ...
those practices eventually began                                  Figure 2: Visante OCT in Practice                       ...
all fee) as well as in diagnosis of dis-        Figure 5: Usage of Visante OCT in the Practice                            ...
Discussion                     Figure 8: Customer Satisfaction and Willingness to Recommend Visante OCT                   ...
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Early user experience with visante oc tfor the anterior segment


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Early user experience with visante oc tfor the anterior segment

  1. 1. Early User Experience with Visante OCT for the Anterior Segment 8 Shareef Mahdavi • SM2 Consulting • Pleasanton, CA 7Optical Coherence Tomography (OCT), initially developed Figure 1: Demographics of Survey Respondentsfor high-resolution imaging of the retina, has more recentlyfound application in the anterior segment of the eye. OCT Practice Typeis unique for the front of the eye in that it allows precision Refractive Only General/Comprehensiveimaging and biometry that previously was available only 9% 19%with Magnetic Resonance Imaging (MRI) or immersion ultra-sound. OCT also allows patients’ eyes to be imaged in a non-contact manner, which is both practice and patient friendly. SM2 Consulting was asked by Carl Zeiss Meditec (Dublin, Cataract & RefractiveCA) to survey and summarize the experience thus far among 41%the first group of customers who have acquired Visante® OCT Multi-Specialty 22%for use in their anterior segment practice. Data from both an online survey and live interviews indi- Corneacate that Visante OCT is providing significant value in refrac- 6% Other*tive surgery as well as cornea and glaucoma diagnoses and 3%treatments. The diagnostic imaging capabilities are aligned # of MD’s inwith recently introduced technologies including Phakic IOLs Geography Setting Practiceand the femtosecond laser for Keratoplasty. Additionally, US 20 Private 27 0* 1Visante OCT provides a level of ocular detail that was previ- Europe 12 Institution 5 1 6 2 5ously unavailable in an everyday clinical setting. This allows 3 6 4 or more 14the physician to have an “offensive” strategy to assist withsurgical planning as well as a “defensive” strategy to docu- Total 32 Total 32 Total 32ment pathology and post-operative complications. The ver- * One of the respondents is an optometric college that conducts clinical researchsatility of the OCT platform suggests that over time and withadditional functionality, Visante OCT could become a “musthave” for anterior segment surgery. Primary and Expanded ApplicationsMethodology and Demographics The most common reasons for acquiring Visante OCT tech- An online survey was sent to the first 75 Visante OCT nology are for use in refractive surgery and anterior segmentcustomers, and responses were received by 32 of them, a 43% imaging. In refractive surgery, the device is primarily used forresponse rate. Of the 32 respondents, 20 practice in the U.S. post-LASIK flap evaluation (62%), measurement of the residualand the remaining 12 are in Europe. Interviews were conducted stromal bed depth (59%) and Phakic IOL planning (56%).with one-third of the respondents to provide greater context and Additionally, 71% of respondents indicate they acquired theunderstanding of Visante OCTs role in the practice. Among technology for imaging of anterior segment structures to betterrespondents, half are either cataract and refractive (41%) or understand and describe the etiology of their diagnoses.purely refractive (9%). The other half are comprised mainly What is interesting is how the use of Visante OCT expandsof multi-specialty (22%) or general comprehensive practices and migrates over time and with experience in the practice.(19%). 27 of the 32 are private clinical practices, with the This can be seen in Figure 2, which summarizes uses into fourremaining 5 being institution-based practices. The distribution categories and then compares the actual usage (once in practice)by the number of MDs in the practice indicates that the device with the planned usage at time of purchase. While the majorityis used in solo, group and large group practice environments. of practices purchased the device to assist with anterior seg-These demographics are summarized in Figure 1. ment imaging (75%) and/or refractive surgery (94%), many of 1
  2. 2. those practices eventually began Figure 2: Visante OCT in Practice to incorporate than similarlyusing Visante OCT for use in Increase in Usage after Installation advanced refractive diagnos-glaucoma and/or planning of Planned application Actual application tics such as wavefront, wherecorneal transplants. The major- surgeons generally report aity of practices in the survey 100% significant impact on clinic flownow use the device in all four 91% 94% coupled with reliance on a singleareas. The versatility of the 75% expert technician to get sufficient 75%device and its emergence as an results for ablation planning. 53% 47%“all purpose” tool for anterior 28%chamber diagnostics is illustrated Frequency of Usage andby comments provided by cornea Corneal Transplant Glaucoma Anterior Segment Refractive Financial Considerations Planning imagingspecialists and refractive sur- As described earlier, usagegeons. For instance, those who purchased the device primarily of Visante OCT often begins with a single purpose in mind byfor post-LASIK evaluation of the flap and/or residual stromal a single surgeon (who typically “championed” the purchase)bed depth have begun using it routinely with pre-LASIK consul- and then migrates to other uses within the practice once othertations. As one practice explained, “We use it with every single clinicians observe the ease of obtaining images and see the qual-consult; it’s truly helpful ity of the images, many ofand has a ‘wow factor’ that Figure 3: Ease of Use which have never beforeimpresses patients, one of % that Agree been available to the clini- vs. Disagree cian. As shown in Figure Strongly Disagree Disagree Neither Agree Strongly Agreewhom described it to us asa ‘catscan [sic] of my eye.’” The data generated are 9% 53% 38% 91% vs. 0% 5, Visante OCT is used easy to interpret on average 11.5 times perEase of Use and Impact week across the survey Getting good imageson Patient Flow does not depend on a specific technician 12% 12% 12% 34% 28% 72% vs. 24% sample. In contrast with a An important factor normalized bell-shape dis-with any new technology The device is easy tribution, the frequency of to use by doctors 3% 6% 38% 53% 91% vs. 3%is evaluating how easy and technicians number of practices alongit is to use in everyday the continuum based uponpractice. Several questions were asked to assess the ease of use usage was fairly evenly spread out. Although not directly mea-among technicians and physicians, which are summarized in sured in the survey, interview comments indicate that the deviceFigure 3. In the survey, 91% agree (somewhat or completely) gains significantly more use over time. “When we first got thethat Visante OCT is easy to use, while only 3% disagree with device, a lot of our physicians were scratching their heads andthis sentiment. And 72% feel that any technician can get good we lacked a process to order the tests,” commented one uni-images, while 24% disagree and continue versity-based corneal specialist. “Now,to rely on a specific technician to generate Figure 4: What term best describes the I don’t know what I’d do if they took it impact of Visante OCT on patient flowquality images. When it comes to inter- during a typical day? away. I’d feel like I lost my left hand.”pretation of results, 91% agree it is easy Most new diagnostic devices gain ato use and no respondent disagreed. market presence only after reimburse- Assessing the impact on patient flow ment has been well-defined by third-party Noneyielded similarly positive findings: 74% 17% payors. In the case of Visante, early adop-of customers felt that the device had no tion is being driven in spite of the lack Significant 6%or minimal impact on patient flow, while Minimal of a defined reimbursement pathway (ie, 57%only 6% stated that the device had a Moderate there is no specific reimbursement codesignificant impact on the movement of 20% in place). This is because Visante is beingpatients through the clinic (see Figure 4). used both in refractive self-pay procedures The findings from both of these (where there is no reimbursement as theareas indicate that Visante OCT is easier test fees are typically included in the over- 2
  3. 3. all fee) as well as in diagnosis of dis- Figure 5: Usage of Visante OCT in the Practice Satisfaction # of Patients Imaged Per Weekease. The framework to show how Among respondents, 29 of 32the device is being used is illustrated 10 Mean Usage 11.5 patients per week (91%) indicate that Visante OCTin Figure 6. (47 per month) has met their expectations based 8 To date, only 15 of the 32 on their initial reasons for pur- # of Practicesrespondents indicated they had 6 chase. Given the additional usagesought reimbursement, and they 4 that most customers have realizedhave done so in one or more of the 2 beyond those initial reasons forfollowing ways: Private insurance: purchase, it is no surprise that in73% (11 of 15), Government insur- 1 to 5 6 to 10 11 to 20 > 20 measures of overall satisfaction,ance: 87% (13 of 15), Patient self- # of Patients per Week 22 of 32 (69%) reported beingpay: 53% (8 of 15). either very or extremely satisfied while only 1 customer (3%) The frequency of submission of claims and the average expressed some dissatisfaction.reimbursement reported in the survey were analyzed and are Frequently mentioned as reasons for satisfaction were thesummarized in Figure 7. Customers reported submitting an high image quality and resolution (15 mentions), ease of useaverage of 17.8 claims each month (14 mentions), and pure amazement(ranging from a low of 8 to a high Figure 6: Main Uses of Visante OCT that they now had a device ableof 25) for reimbursement. On aver- to capture these images within aage, Visante OCT images were clinical setting (10 mentions). There Visante OCTreimbursed at $60.14 (ranging from were 9 out of 32 customers in the$30 to $120). In Europe, by com- survey (28%) that indicated theyparison, reimbursement seems to were only somewhat satisfied, citingbe averaging in the range of 80-85 that they were hoping this device Refractive TherapeuticEuros per claim. Multiplying the would replace older technology theyaverage reimbursements by the aver- already owned (e.g., the Orbscan).age number of submissions reported Main Uses Main Uses Other comments from this groupyields an average monthly revenue Pre-LASIK consultation Glaucoma angle imaging included their desire to see Visante Post-LASIK flap evaluation Iris tumors/corneal anomaliesfrom Visante OCT reimbursement Phakic IOL Corneal transplant planning OCT upgraded with better softwareof $1,071 in the US and 1,765 to extract data that is being col-Euros in Europe. These rates are lected, the incorporation of corneal Non-Reimbursable Potential forindicative of what can be achieved (Part of refractive surgery fee) Reimbursement curvature/topography, and imagingearly on and should only increase capabilities that extend behind theover time, especially once an official iris to precisely image the sulcus andreimbursement pathway is defined in the US. the lens equator. Given that the majority of use has been in non-reimbursable Customers were also asked how they respond to other physi-elective refractive procedures, the fact that disease diagnosis cians who are considering the device for their own practices.can help cost justify the device is a 85% of respondents indicated theypositive for the clinician. Using the Figure 7: Reimbursement for Visante OCT either completely agree (53%) or Averages and Rangesdata in the survey as a baseline, it somewhat agree (32%) that theyappears that the device will break- would willingly recommend Visante Low x=mean Higheven over a 5-year period (useful OCT to their colleagues. Only 2 of Number of cases submitted per monthlife for a diagnostic device). With 32 respondents somewhat disagreed 8 x=17.8 25increased reimbursement revenue and no one completely disagreed Reimbursement per casefrom a formal code, greater usage, with this sentiment. The distribution $30 x=$60.14 $120or both, the time frame for paying of responses to these two questions Reimbursement per monthback the investment will be shorter. on satisfaction is summarized in $540 x=$1,071 $1,125 Figure 8. Based on data from 15 of 32 surve y res p ondents 3
  4. 4. Discussion Figure 8: Customer Satisfaction and Willingness to Recommend Visante OCT eral years to establish The rapid rate new codes and rates.of innovation in the How satisfied overall are you with Visante OCT? Visante OCT has an Very Unsatisfied 0 0%ophthalmic sector has Unsatisfied 1 3% additional benefit offorced clinicians to Somewhat Satisfied 9 28% indirect reimburse- Very Satisfied 14 44%continuously evaluate Extremely Satisfied 8 25% ment as part of anew devices and ask Total 32 100% larger global fee forthemselves two basic "I would willingly recommend the Visante OCT to a colleague" specific refractive pro-questions: Completely Disagree 0 0% cedures. These tests Somewhat Disagree 2 6%“Will this tool help Neither Agree nor Disagree 3 9% are embedded in amy practice?” and Somewhat Agree 10 31% larger suite of services Completely Agree 17 53%“Can I afford to Total 32 100% provided as part ofincorporate it?” the refractive package,Visante OCT provides capabilities that heretofore never existed; collectively performed to drive better outcomes in these self-payits images fall outside the current paradigm of how the anterior procedures.chamber is evaluated. This helps explain the dichotomy seen in The emerging definition of reimbursement incorporates thethe data and interviews, with some customers saying “this is a trend towards elective medicine, where patients themselves payneat device and I’m still trying to figure out all it can do” while – rather than wait for someone else to cover the expense – forothers express that “I use it everyday on nearly every patient.” the benefits of novel medical technology. Given this shift, it As a sophisticated diagnostic tool, Visante OCT’s arrival is was surprising to see that only a small percentage of custom-timely based on the following surgical developments: ers leverage the presence of Visante OCT in their practice. Less1) Increasing awareness and need to reduce the risk of ectasia than a third (9 of 32) regularly show off this “new technology”in LASIK. to their patients, and the majority (19 of 32) say they have2) The advancement of Phakic IOLs as another tool in the observed no marketing value from the technology. In hindsight,refractive armamentarium. the question would have been better asked as, “have you cre-3) The revolution in corneal transplantation afforded by the ated any marketing value for your practice?” There are numer-femtosecond laser and its role in keratoplasty. ous means of describing the device that can be implemented With time and exposure, anterior segment Optical Coherence nearly free but can have a big impact on patient perceptionTomography is likely to move into the mainstream. Today it sits of the practice. One surgeon described this phenomenon verywith the “innovator” clinicians, who tend to be the very first to well: “Patients love all the tests and Visante has become aadopt new technologies, simply because they are available. The practice builder. We tell them, ‘good news, there’s room forsituation is reminiscent of corneal topography 15 years ago; it your implant’ while we show them the images.” That momentwas viewed as a “nice to have” but the mainstream clinician becomes a differentiated event in the mind of the patient andwas not clear on its utility. All of that changed with the advent demonstrates how a new technology can create great return onof the excimer laser, and today corneal topography is indispens- investment for the practice.able to the refractive surgeon. With the 3 surgical innovations In summary, Visante OCT technology has the potential tocited above (and likely many more to come), it is reasonable revolutionize the way surgeons plan and treat throughout theto expect that OCT technology will improve and become more cornea and anterior segment. Customers are largely satisfiedvital to refractive, cornea and glaucoma specialists. and also want to see the technology improve in order to be With respect to the second question posed above, the tra- more useful to them as well as evolve to standard use amongditional view has been to evaluate each new technology based cornea and refractive specialists. The manufacturer (Carl Zeissupon the opportunity for insurance reimbursement. Given its Meditec) has a heritage of innovation in automated diagnostics,relative newness in the marketplace, it was surprising to learn and Visante OCT provides another opportunity for the com-that nearly half the customers surveyed were already obtaining pany and its customers to create yet another market categoryreimbursement revenue. For new technologies, it can take sev- that improves patient care.© Copyright 2006, SM2 Consulting. All rights reserved. 4