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Considerations for In-Office Cataract Surgery

It is a big transition to relocate a surgical practice, especially when thinking outside of what is considered “normal”. It is both exciting and challenging to work through.  Lance Kugler, MD of Kugler Vision in Omaha, NE shares his experience on his transition to in-office cataract surgery, his initial concerns and why he chose to move forward.  

Prior to 2016, Dr. Kugler took his cataract patients to an ASC across town.  While the ASC had excellent equipment and a good patient experience, he knew it would never be quite as good as the experience of his Lasik patients in the office. That is what led him towards the alternative of in-office cataract surgery.  Like many surgeons considering this transition, he had initial concerns regarding safety, staff training and anesthesia.


A common misperception is that in-office surgery is done in a clean room or a procedure room.  Office-based cataract surgery is performed in a full iOR suite.  It has the same safety standards, protocols, and sterility as you would find at an ASC.  The difference is the terminology around it, how it is credentialed, and how the processes are documented.   Dr. Kugler realized that his office-based cataract suite would be a real OR. This eliminated his safety concerns.

Dr. Kugler researched the published data on in-office surgery suites and found that there was more published data regarding safety for office-based suites than there was for ASCs. A retrospective study conducted at Kaiser Permanente of 21,501 cataract surgeries found office-based cataract surgery efficacy and safety outcomes to be consistently excellent as those performed in ASCs.[1]  In over 5,000 procedures performed in iOR facilities, the safety profile is consistently as good as those in the study. (iOR data involves patients of a younger population than those in the Kaiser study.)

Staff Training

Dr. Kugler’s staff had never done intraocular surgery before and he had concerns about hiring a new surgical team. iOR Partners helped him identify existing staff members for specific surgical roles and put them through our surgical training program.  Our surgical experts worked with them until deemed competent.  “We were able to train them to be, honestly, the best OR team that I’ve ever worked with,” says Dr. Kugler.


Prior to having an office-based surgery suite, Dr. Kugler had an anesthesiologist or a nurse anesthetist onsite to provide IV sedation for cataract surgery.  The idea of doing this procedure without IV sedation was a new concept to him. After speaking with other surgeons who routinely used Class A anesthesia, he became more comfortable with the idea and tried it himself at his ASC. Dr. Kugler soon realized that oral or sublingual sedation was adequate and even patient preferred. He found that his patients were more relaxed and did not feel like a hospital patient. Now, Dr. Kugler prefers oral sedation and finds it to be a safer and more comfortable way to perform cataract surgery.

Setting up an in-office cataract surgery suite to the highest safety standards is a big undertaking. It requires expertise to do it right.  It is critical to have a deep understanding of the space requirements, surgical equipment, staff training, accreditation, the entire billing process and how to set up efficient processes. Dr. Kugler chose to work with iOR Partners because of our laser-focused expertise in office-based cataract surgery.  As the only company dedicated to ophthalmic office-based surgery, we work with practices to achieve seamless integration of clinic and surgery in just a few short weeks with no surgery downtime.  Learn more about iOR Partners office-based surgery suites.


  1. Ianchulev T, Litoff D, Ellinger D, Stiverson K, Packer M. Office-Based Cataract Surgery: Population Health Outcomes Study of More than 21,000 Cases in the United States. Ophthalmology. 2016;123(4):723-728.