Incorporating New Techniques and Technologies

Consider these 5 action steps to achieve success

As H.G. Wells once said, “Adapt or perish, now as ever, is nature’s inexorable imperative.” We are fortunate that ophthalmology is constantly evolving with new techniques, such as a partial thickness keratoplasty, and technologies, such as presbyopia-correcting IOLs. Continued progress carries the potential for improved patient care, keeps our careers interesting, and can both preserve and/or expand patient referrals and, therefore, the maintenance and growth of revenue.

With all this in mind, here I provide 5 action steps to achieve success in incorporating new techniques and technologies in our practices.

Having a check list of the action steps mentioned facilitates accomplishing them.

1. Do Your Homework

Education is key. The corneal surgeon’s pursuit of knowledge should be framed around these 5 important questions:

  • What. What is the new technique or technology?
  • How. How, specifically, does it work, and how do I perform/use it?
  • Who. Who is the best candidate, why, and are there enough patients who can benefit to make the incorporation worth it? As an example, will you have enough refractive surgery patients who can benefit from that innovative laser you received an eblast about? Time to dig in to your patient records for the answer.
  • When. Is there enough data about the technique or tool to support its use? A business plan is a must to help you decide whether the new pursuit is truly worth your time and money. The business plan should include estimates for capital investment, leasing fees, anticipated revenue, operating expenses, staffing requirements, and marketing costs.
  • Where. Does the practice have the physical space for it? Is there a particular OR better suited for using it?

Luckily, multiple resources are available to complete this homework. For “what,” “how,” and “who,” PubMed ( ), professional societies (providing members access to associated journals, video libraries, webinars, and white papers), YouTube channels, professional meetings (which offer a broad collection of skills-transfer courses on IOL exchange, iris repair, corneal endothelial transplantation, etc.), and industry partners, such as the manufacturers of new technologies, can provide the needed education to begin implementation.

For example, when an artificial iris became available for general use, the manufacturer required surgeons complete a series of web-based didactic training modules and were sent a sample product to practice with in a dry lab setting.

For “where,” practice staff will have to assess the space needed for the new technique or the footprint of the device in relation to the practice space available. (See “Avoid Analysis Paralysis”.)

2. Practice, Practice, Practice

Pursue wet and dry simulation resources to prepare for the first patient encounter when using a new technique or technology. Resources, such as model eyes, can be purchased online. Additionally, many simulation resources are available, and national meetings, such as those of ASCRS and AAO, offer proctored wet labs by other surgeons and industry professionals.

Additionally, see whether your surgical center may allow you to practice certain procedures in their facility prior to your first case. While they may not permit the use of porcine or other types of cadaver eyes, they would likely allow you to use artificial eyes.

3. Communicate With Your Patients

Accurately convey the various risks and benefits of the new technique or technology to present a realistic picture to patients, so they don’t experience any negative surprises. Comparing the risks and benefits of the traditional versus the new will help patients make an educated decision that will increase their confidence in their ultimate choice.

The tone of the discussion is also critical for establishing an acceptable comfort level with the proposed plan: Rather than presenting a stark picture of new and unfamiliar territory, focus on how your prior experience has prepared you for the new technique or technology.


To prevent overthinking whether to incorporate a new technique or technology, define your pace for moving forward.

For example, I was a comfortable Descemet’s Stripping Automated Endothelial Keratoplasty surgeon for many years when Descemet’s membrane endothelial keratoplasty (DMEK) came along. While the benefits of DMEK, such as quicker visual recovery and improved visual outcomes, became readily apparent, its early days came with technical challenges, such as tissue preparation and graft unscrolling. As a result, I waited for my colleagues to work out these bugs before incorporating this new technique into my practice.

On the other hand, I embraced the technique of IOL placement via flanged intrascleral haptic fixation shortly after it was described by Dr. Shin Yamane. I enjoyed the process of figuring out its nuances.

A little introspection in this area can be quite valuable: Do you consider yourself an “early adopter,” or do you prefer to wait until the “shiny new toy” has transitioned to a state of proven success? Whatever your philosophy, strive to avoid “analysis paralysis.” No surgical technique or medical device is entirely without risk. If you drag your feet waiting for perfection and certainty, patient care and your practice could be deemed outdated.

4. Seek Colleague Support

As English playwright, John Heywood once said, “two heads are better than one.” When trying something new, it can be helpful to have a colleague in the OR with you or at least nearby. In addition to filling the role of security blanket, this person can also help brainstorm the surgical approach or serve as a sounding board for your surgical plan. This is particularly true if the colleague has prior experience with the technique or technology that’s new to you. If they can’t be present in person, they will likely be available ahead of time to discuss the procedure by telephone, email, or video conference.

Back in the day, when we started performing Descemet’s stripping automated endothelial keratoplasty (DSAEK), two of my partners and I scheduled our first cases on the same day, so we could all be present to help each other.

Professional society listservs, such as the Cornea Society’s Keranet, provide a ready conduit to a large community of practitioners whose collective experience can be invaluable, as you navigate through uncharted waters.

5. Get Comfortable

Create a “Zen-like” situation, so you and your team are well-prepared and, therefore, in a state of calm to try something new. Consider setting aside additional time for the new technique or technology, lightening the patient load for that day, and accounting for every related detail in advance, such as mapping out a step-by-step plan, assembling a well-defined supply list, and preparing a sketch you can reference during use of the new technique or technology. Additionally, involve the OR staff in your preparation, so they know what to anticipate.

Finally, have a plan B (and C, D, etc.). Despite exhaustive preparation, things may not go as planned, so an alternate pathway can pay off in dividends. For example, what will you do if you can’t unscroll the Descemet’s membrane endothelial keratoplasty graft? Should you have DSAEK tissue available? What if you can’t fixate the IOL with the new technique? Will you have other IOLs available and alternate means for their fixation? What if the patient doesn’t tolerate the new presbyopia-correcting IOL? Have you discussed the possibility of additional procedures, such as IOL exchange with the patient? The presence of an alternate strategy will go a long way toward increasing your comfort with the existing plan and increasing the likelihood of patient satisfaction with the end result.

The Benefit

By following the 5 action steps outlined above, you can incorporate new techniques and technologies successfully, ingraining you in the patient’s mind as the go-to doctor for the “latest and greatest.” This reputation creates patient loyalty and referrals. CP