Philadelphia nanoFLEX Plus IOL Provider – Dr. James Lewis
Serving Bucks County, Phoenixville, Conshohocken, Delaware Valley, King of Prussia, Warminster and Montgomery County
Surgeons experienced with the Staar (STAA: Monrovia, CA) Collamer Intraocular Lens (nanoFLEX:CC4204A ) realize it is not a standard implant. The Collamer Accommodating Study Team (CAST: Results on file.) showed that bilateral nanoFLEX pseudophakic emmetropes had an average unaided binocular intermediate vision of 20/25. Furthermore, the study revealed binocular unaided near acuity averaging 20/46. These results were based on distant corrected acuities and did not rely on blended vision, mini-monovision, or any other such artifice. Whether it is the material, the optics, or the architecture of the implant, Staar’s nanoFLEX provides functional accommodation not found in its monofocal competition.
Although Crystalens® has been deemed “accommodative” by the Centers for Medicare and Medicaid Services (CMS), Bausch and Lomb did not achieve accommodative status for their Crystalens Trulign Toric despite an identical geometry, composition, and manufacturing process. Few Trulign surgeons address this distinction. In most practices the Trulign is considered an accommodating implant with toric correcting abilities in stark defiance of the CMS ruling.
Considerable efforts have been made to measure and validate active accommodation in Crystalens pseudophakes with limited success. Although the optic position may change and the anterior lens surface may vault, this has not entirely explained the measured improvement in near acuity. Most have accepted that something is happening in Crystalens patients resulting in enhanced unaided near and intermediate vision.
This same improved functional accommodation is found in Staar’s nanoFLEX. But this lens easily traverses a 2.2 mm incision and includes a well-centering 6 mm dual surface aspheric optic. Furthermore, because Staar never applied for premium status with CMS, the cost to the surgeon and/or surgery facility is consistent with that of other standard monofocal implants.
Premium Implant versus Premium Service
Few patients comprehend Medicare’s distinction but cataract surgeons must fully understand their ruling. Surgeons can use a designated premium implant and may charge a small handling fee and a modest up charge based on lens cost. Additional premium services such as astigmatism correction, patient counseling, imaging studies of macula health, corneal shape and power, optic nerve functionality and post-operative refractive services including LASIK or IOL exchange can be added to justify the total fee. Simply inserting a presbyopia correcting IOL or a toric IOL does not justify much more than a $100 payment increment.
As premium surgeons we define ourselves by refractive results and enhanced patient satisfaction. Again, we are not being paid a commission for installing a Crystalens, ReStor, or the Tecnis Multifocal. Premium surgery does not require a CMS-approved presbyopia or astigmatism correcting implant. It is defined by a premium service and supported by improved patient satisfaction. FemtoSecond cataract surgeons have helped validate and elucidate this important subtlety.
With the guidance of Alan Reider, ESQ, I have been marketing nanoFLEX Plus as a premium option for three years. Patients can expect an enhanced refractive result employing Staar’s nanoFLEX intraocular lens as demonstrated by the CAST study. Our premium services includes topography, wavefront assessment, determination of corneal power (including RGP lens over-refraction), binocular visual function assessment, endothelial cell count, global pachymetry mapping, pre-treatment of dry eye, refractive expectation counseling, macular and optic nerve assessment by OCT and visual fields if necessary. Post-operatively these patients receive contact lens trials and Bladeless LASIK if a modification of the final refractive state is indicated. These services are extensive and easily justify a substantial charge.
The nanoFLEX can be procured for less than $150 thereby saving surgeons between $500 and $1000 per eye. nanoFLEX Plus patients obtain to the same added services provided our Crystalens patients. The net difference to the surgeon is an added profit of as much as $2000 per premium candidate or the competitive advantage of offering a lower cost premium option. Post-operative management mimics standard premium implants except for the unusually graceful manner in which nanoFLEX tolerates YAG capsulotomy.
I have successfully used the nanoFLEX in dozens of patients with retained retinal silicone oil. I have used nanoFLEX in DSEK, lax zonules with endocapsular rings, and in cataract surgery combined with glaucoma filters, stents, and tubes. Its superior biocompatibility, superior mean transfer function (MTF), and overall resiliency
nanoFLEX biocompatibility as a result of its unique composition make it my main implant for standard cases. Those choosing not to select nanoFLEX Plus keep their astigmatism and can’t obtain a refractive enhancement for mild ametropia without paying the full cost of refractive surgery.
Staar’s incredible success with the phakic Visian lens is in no small part due the excellence of the collamer material. Its outstanding design, optics, and biocompatibility has made the ICL the international favorite.
Using this incredible material in standard cataract patients may cost a bit more than generic implants but the enhanced range of visual function yields fewer complaints and a more satisfied postoperative patient.
For years, Staar’s implants beginning with the Mozzacco Taco have been marginalized by comments like, “its a plate haptic”, or “it’ll fall into the vitreous after YAG”. Unfortunately, some surgeons still cling to these absurd platitudes. Alcon’s Acrysof is America’s most popular implant and it is a plate haptic! Having inserted at least 30,000 Staar plate haptic IOLs, I have had two silicone lenses that subluxed after YAG. There have been no untoward complications in the last 25 years. I have yet to find a glistening nanoFLEX.
Adding nanoFLEX Plus
Experienced Premium Surgeons can add nanoFLEX Plus to their offerings. Expect to capture more patients for premium services when you provide a more affordable option. Some surgeons might conclude that the aggravation of a 5 mm optic and an occasional Z-Syndrome can be eliminated with no loss in patient satisfaction and with a substantial gain in practice revenue.
Surgeons, who have not yet addressed the premium market, can learn the unique characteristics of nanoFLEX in routine cases. Once satisfied, the path to premium surgery becomes less daunting and far less treacherous.
The Premium Experience
Success in the premium marketplace is tied to excellent results and the absence of complications. Perfect surgical technique and postoperative management does not prevent the occasional Z-Syndrome and its repercussions. A perfect or femto-perfect capsulotomy does not eliminate visual disturbances associated with a 5 mm optic. Finally, the respected lineage of AMO, Bausch & Lomb, and Alcon do not ameliorate the complaints of premium patients with residual astigmatism, mild hyperopia, or glare and halos associated with night driving. The Premium surgeon must rely on a solid performer without syndromes, glistenings, or sub-optimal intermediate vision. He or she must carefully march the patient through YAG capsulotomy and final visual endpoint refinement if indicated. nanoFLEX Plus provides a consistent platform for this process and leads to a more physician-centered premium experience.
James Lewis, MD is a practicing cataract and refractive surgeon with a special interest in cornea. He practices in Philadelphia and surrounding suburbs and has been a strong proponent of Staar implant technology for several decades. He is not a consultant for staar.