Eye surgery is an accumulation of small, well-conducted steps.  In order to advance in this kind of surgery, we need to train ourselves for many years, managing to dominate our instruments, to have confidence and safety so that these steps allow us to go onto the next ones.

Since the year 1995, I have been using the 1.00 mm width diamond knives of the company Rumex to conduct my cataract surgeries, cornea transplants and trabeculectomy. 90% of my incisions are sclerocorneal as I think that different works published on endophthalmitis and corneal incisions versus scleral ones produce a rate of 0.05% of endophthalmitis for scleral incisions and 0.29% for corneal ones.

Initially, I was using the Universal Straight Side Port Diamond Knife with 1.00 mm trifaced blade of Rumex (6-10/6-053). However, currently, I am very comfortable with the ones with trapezoid self-diving blades like 6-10/052 or 6-10/6-070, which have an excellent end with an edge and this allows me to make the incision with safety and confidence to have it valvulated. The cost of surgery has decreased remarkably as the instruments can last years with the proper care.

To enlarge the sclerocorneal wounds, I use a scalpel of surgical steel according to the size of the wound that I need to make, currently making it as small as 2.0 mm.

The versatality of the scalpel also allows me to use it in trabeculectomy, the procedure of cutting the scleral lid, which needs to be as soft and precise as possible. 

With the use of the 1-mm Rumex diamond, we can control the depth and cut carefully to later make the entry into the chamber and conduct trabeculectomy with Punch.

These diamonds also allow me to make and complete the cut in the trepanation of the cornea. I choose to use them due to the edge they have, which does not require any pressure at that moment as any pressure could lead to damage in the adjacent structures, such as the crystalline and the iris.

I also use a diamond scalpel to make my accuate incisions to lower astigmatism.
For those patients that have 1.0 dp to 2.50 dp of astigmatism and cannot pay the cost of toric lens implants, I make relaxing incisions according to the nomogram of Dr Nichamin from Pennsylvania (USA). The preset scalpels offer the possibility of using them at required depth that range from 600 microns (the pre-set LRI knife 6-600S/6-0531 is the one I use) to 500, 350 or with the free mode.

This means that I can use it for other surgeries, such as with marking the scleral lid in trabeculectomy, or using it for valvulated scleral incisions (350 microns).
I use SKY, which provides help for the wound so that the wound does not go deeper. And in the free mode, it can be used as a paracentesis or incision scalpel.
In short, my relationship with Rumex is mainly based on its excellent scalpels that have accompanied me since my first surgeries.

Watch micro incision cuts with Rumex diamond knives video:

Dr. Pablo Luis Daponte Mr. Daponte is the owner of Centro Integral de Salud Visual Daponte, Buenos Aires Argentina  and university teacher. He is the President of Argentine Council of Ophthalmology, an institution that brings together all the societies and departments of ophthalmology in Argentine and it has 3500 ophthalmologist members.

Mr. Daponte is a specialist in anterior segment surgery, he does cataract surgeries, cornea transplants, insertion of lenses for high myopia (Artisan and ICL), valvulae. He has been working with Rumex diamond knives for twenty years and buys our scalpels every year. Using Rumex diamond knives Dr. Pablo Luis Daponte have conducted around 40.000 surgeries.

What makes an ophthalmological practice successful? Some may say the quality of the professionals at work, others may point to the use of advanced technologies, while others would argue that strong patient-client relationships are what makes or breaks a practice. We agree that each of these factors contribute to success, but would add that an effective ophthalmological practice is also one that always takes time to pay attention to the little things, such as keeping a well-stocked office. 

Maintaining an office that's always stocked with quality ophthalmic tools, such as vitreo cannulas, eye forceps, scissors, needle holders, corneal transplant instruments and other items, is essential for providing patients with consistent, high-quality service. Tools like disposable vitreo cannulas and various types of eye forceps are needed for a wide variety of common eye procedures, from chalazion removal to retinal surgery. What's more, these procedures may sometimes require the use of a specific variation of a tool, a necessity which may only be brought to an ophthalmologist's attention immediately prior to or before a surgery. For example, after closer evaluation, a patient's retinal surgery would be best performed with a larger millimeter cannula than what is currently in stock; such a situation is when keeping an office well-stocked or purchasing a vitreoretinal set, complete with a large variety of cannulas, proves essential.

An ophthalmological office that's well-stocked is also one that has tools on hand for any type of procedure, not just those that are most common or those scheduled for the upcoming week. The reality is that an ophthalmologist's office may be required to perform unexpected emergency procedures at a moment's notice, such as a preventing a retinal detachment or treating a damaging eye laceration. In extreme cases, letting supplies dwindle or forgetting to re-order a niche tool could severely impact a patient's eye health.

The good news is that re-stocking ophthalmic tools doesn't have to be accompanied by steep costs. Most common ophthalmic tools and microsurgery instruments can be found at competitive prices; for example, at Rumex, because we're a manufacturer, the cost of our tools is 10-20% lower than those offered by reseller companies. In other words, practitioners can save significantly over the course of time when purchasing from a manufacturer. We make ordering supplies much easier as tools can be delivered to an ophthalmological practice within a matter of days; at Rumex, we ship out of European and U.S. locations to ensure quick delivery and will even waive shipping fees depending on the cost of a purchase order.

For more information on eye surgery instruments for keeping your practice supplied, browse Rumex products online.

As an ophthalmologist, you know that your credibility as a medical professional depends upon more than just your knowledge and skill set. Like any professional in a service field, you're also evaluated on your ability to make ethical decisions. While we may typically think of ethics as involving doctor-patient confidentiality, an ethical ophthalmology practice is also one that consistently relies on the best surgical tools and equipment available.

Why does a commitment to quality surgical tools matter? The truth is that even the most talented, insightful ophthalmologists disserve their patients and, quite frankly, act unethically, when surgical tools and equipment are outdated, in need of repairs, or ill-suited to the specific surgery at hand. There's no amount of experience or skill that can make up for an instrument that features manufacturer defects with the potential to botch an operation. Given the intricate, delicate nature of eye surgeries, whether a limbal relaxing incision that relies on the precision of a toric marker, or an intraocular lens implant following cataract removal, one defective or inadequately-built tool can outright ruin a surgery.

Not all ophthalmological instruments are created with the same care and attention to quality as those manufactured by Rumex. When ophthalmologists neglect to ensure that the instruments they use on hundreds of patients are guaranteed by manufacturers to perform as expected, they run the risk of damaging their reputation as a respected physician or worse, incurring damage to a patient's eye. As an ophthalmologist at the head of your practice, it's ultimately your responsibility to ensure that every aspect of your operations, from patient consultations to the use of eye instruments, is carried out in an ethical manner.

How can ophthalmologists accurately identify well-made surgical instruments that will ensure patients undergo surgery that's truly safe?

• - Instruments are well-made when constructed with high-quality materials, such as non-corrosive stainless steel and titanium, both of which are guaranteed to provide durability and longevity.
• - Ophthalmologists should look for tools from manufacturers that have consulted with leaders in the field of ophthalmology. Companies that don't seek out the expertise of professionals lack the type of key insight that could lead to improvements in design and production.
• - Reliable manufacturers implement strict quality control standards that, at minimum, meet FDA criteria. At Rumex, our commitment to exceptional quality control allows us to make a 100% percent guarantee that our instruments are free of manufacturing defects and will offer exceptional performance for the duration of their use.
• - Ophthalmologists should seek instruments that feature innovations. Surgical tools made with unique, advanced features, such as ergonomic handles, indicate that a manufacturer intimately understands the industry.

Learn more about what makes for high-quality eye instruments to ensure your practice continues to operate ethically by visiting Rumex online. 

You may have noticed an influx in patients at your ophthalmology practice over the course of the last year; wait times may have increased in length, more surgeries may be scheduled, and new patients are likely arriving at a faster pace. That's because the number of individuals seeking ophthalmology services is increasing nationwide.

The growing popularity of corrective eye procedures is one reason for this increase. Eye procedures once considered to be major operations, like the LASIK or PRK eye surgeries, are now seen as safe and viable options for individuals with poor vision. More than 12 million people have had LASIK eye surgery alone since 2002. Ophthalmologists are also witnessing an increase in younger cataract patients, which is likely the result of better detection methods and a host of environmental factors that contribute to overall poor health.

Additionally, as the baby boomer population ages, more will be in need of procedures to treat cataracts, macular degeneration, retinal detachment, and other eye conditions common among the elderly. In fact, for the next 20 years, 3 million baby boomers will enter the Medicare system each year; this will undoubtedly mean more patients for eye care professionals.  The introduction of the Patient Protection and Affordable Care Act has already resulted in significant increases in Medicaid procedures performed in 2014 and 2015.

So as your ophthalmology practice prepares to treat an increasing number of patients, how can you ensure quality service continues?

A Supported Staff

As your practice expands, you'll need to ensure that your staff is prepared to meet new demands. Focus staff meetings on new strategies for scheduling, patient accommodation and staffing, and actively listen to what your team has to say about how they're managing increased levels of patients. Be sure to hire more staff as needed to avoid stretching your current staff too thin.

Exceptional Technology and Instruments

It's important to maintain the latest technologies and instruments in a practice to ensure that procedures are conducted as smoothly and efficiently as possible. Investment in these items will yield valuable pay-offs to both patients and ophthalmologists. Regularly assess your inventory of tenotomy scissors, vitreoretinal forceps, toric markers and other surgical tools to ensure that they're in top condition, and consider if newer models would make your surgeries more effective. Keeping an eye out for advanced technologies will also help increase the efficiency of your practice, and in turn, help you treat more patients.

Patient Feedback

Regularly ask patients to conduct a satisfaction survey to provide feedback of their experience at your office. Are wait times too long? Are doctors and staff as attentive, organized, and accommodating as they've always been? Were there any issues with scheduling or payment processing? How your patients feel about their experience in the coming years can be an indication that it's time to expand your practice, hold off on accepting new patients, or continue in the same manner.

How satisfied are patients of your ophthalmology practice? The answer to this question is an important one, and will continue to be so in the coming years. Despite what we know about expected increases in the number of ophthalmology patients, ophthalmologists won't be able to benefit from this influx without continuing to improve patient satisfaction. Why? Patient satisfaction plays a significant role in the success of healthcare practices, even when demand for services is high; in fact, word-of-mouth remains the primary way individuals choose a healthcare professional. Additionally, according to Forbes.com, an increasing number of businesses and insurance companies are interested in metrics concerning patient satisfaction, with some even proposing that a percentage of physician pay be based on patient satisfaction scores. While these aren't widely-implemented ideas as of yet, they do underscore the continued importance of patient satisfaction.

So how can your ophthalmology practice find simple ways to better satisfy patients?

Emphasize Quality Consultations

Today's patient is arguably more concerned with their health than ever before, and with easy access to an abundance of information on eye health and specific eye procedures, expect patients to attend consultations with more detailed and informed questions. While some procedures may be urgent, and therefore leave patients little time to "shop around" for the best ophthalmologist, common procedures like corrective lens surgery and cataract removal afford patients the time to conduct research and attend multiple consultations.

What will set your consultation apart from others is demonstrating your breadth of knowledge in a way that's clear and easy-to-understand, discussing alternative treatments, and being honest if you feel a procedure is not the best course of action for a patient. 

Leverage Advanced Technologies and Instruments

Equipping your practice with advanced technologies and high-quality microsurgery instruments like vitreoretinal scissors and eye forceps can result in higher patient satisfaction for two reasons. First, better technologies and instruments reduce the chance of error during a patient's procedure; second, these cutting-edge technologies and tools often make procedures more expedient. This allows ophthalmologists to treat patients faster (increasing their satisfaction), and in turn see more patients (reducing patient wait times). 

Be Personable and Polite

While this may seem an obvious word of advice, there are ways to better communicate your sincerity to patients. Patient satisfaction is not just about the end result of a procedure; it's about how a patient feels while in your office, and it can sometimes be difficult for ophthalmologists to maintain a consistent level of courteousness and cheerfulness given the fast-paced nature of the job. To avoid coming off as brusque or indifferent to patients—even though you may just be tired or stressed—take care to: 

• - Address patients by name.
• - Make strong eye contact and greet patients with a handshake.
• - Ask if patients have any questions.
• - Offer to supply patients with additional resources.
• - Listen. Refrain from interrupting patients when they're expressing questions or concerns.
• - Always end an appointment with a friendly farewell.

Cataract surgery is one of the most commonly-performed ophthalmic procedures. Every year, approximately 10 million individuals around the world undergo cataract surgery. While the prevalence of this operation has afforded many ophthalmologists the opportunity to gain experience and confidence, there are still always opportunities to improve surgical performance. Additionally, as more developing countries gain access to ophthalmologists who can perform cataract surgeries, and as individuals in first-world countries become more proactive about their eye health, we can only expect the demand for cataract surgeries to increase in the coming years.

So as an ophthalmologist, how can you improve the quality of the cataract surgeries you perform?

Ensure Staff is Well Trained in Measuring Visual Acuity

Visual acuity is the primary indicator of cataract surgery clinical success. Measured before and after a surgery, visual acuity must be extremely precise if interpretation of surgery results is to be accurate. However, when junior staff members or poorly-trained staff members are unable to document accurate visual acuity measurements, you may be led to believe your cataract surgeries have helped patients more than they have. Take time to test the skill and ability of all members of your staff for this critical skill on a regular basis. 

Note and Address Complications

The only way to improve your performance is to recognize in what ways you could improve, and surgical complications are prime opportunities to conduct such assessment. When complications during cataract surgery arise, it's essential to document them in full detail, noting the specifics of the complication, when it occurred during surgery, and final patient outcome. After documentation, you'll need to determine what went wrong, and how that same complication could be prevented in the future. Doing such is in many ways a matter of ethical practice. When the cause of a complication is confounding, it's important to reach out to other ophthalmologists or members of your professional organizations for additional insight.

Prioritize Patient Safety

The most important measure of success for cataract surgery is patient safety. Patient safety must be placed above all other aims, and though this may seem fundamental, it can be easy to unconsciously lower your safety standards after conducting hundreds of surgeries and gaining confidence in your abilities. To improve safety, always review a patient's medical history and risk for complications right before surgery, ensure that your cataract tray of instruments, which should contain items like tenotomy scissors, choppers and capsulorrhexis forceps, has been properly sterilized and that items are in good condition, and always be well-rested and alert. And of course, never conduct cataract surgery on both of a patient's eyes on the same day. For a refresher on general surgical safety, review the World Health Organization's Surgery Safety Checklist.

These comprise just some of the many ways ophthalmologists can improve cataract surgeries. For more information on topics related to ophthalmology and ophthalmic instruments, check in with the Rumex blog regularly!

The Necessity of Ongoing Ophthalmic Education

As a practicing ophthalmologist, we know you've survived years upon years of intense undergraduate and graduate training. You've no doubt worked hard for your doctoral degree and are well-deserving of your successes. It's therefore likely that the last thing on your "to-do" list is to complete even more education and training, on top of running your practice.

However, envisioning yourself as a continual learner is essential for operating a successful ophthalmic practice. This doesn't mean that practicing ophthalmologists necessarily need to sign up for additional college courses or training programs; rather, continued learning can be the result of self-guided discovery, made possible by a breadth of new online resources.

These include a wide range of Master Class video and audio lessons from the American Academy of Ophthalmology and over 500 ophthalmology videos from the Wills Eye Hospital, all of which are available for free. Additionally, the International Council on Ophthalmology's on-demand recordings of the World Ophthalmology Congresses can give ophthalmologists any-time access to meetings of the world's leaders in ophthalmology. OphthalmologyWeb also features a collection of articles, videos, and information about common ophthalmic products, while the Root Eye Network provides helpful overviews of specific ophthalmic procedures.

Almost all of the online resources that ophthalmologists will find are completely free of charge, and the select resources that do require a fee only ask for a minimal amount. This means that continuing your education in a self-paced fashion doesn't have to come at a significant cost.

Why is taking advantage of these free, flexible educational opportunities so important?

By doing so, you'll be able to benefit from:

• - Tips for ensuring better surgical outcomes
• - Detailed introductions for new procedures and surgeries
• - Access to cutting-edge research that could better inform your care
• - Refreshers on best-practice techniques
• - Answers to technical questions
• - Information about new, more advanced technical instruments

By electing to spend time each day or week reviewing these ophthalmic online resources, you'll ultimately be able to offer your patients a better level of care, and there should be no greater motivation than that.