Hovanesian backs 110,000 office cataracts
- John Hovanesian is making the case that cataract surgery’s next shift is into office-based surgical suites, not just traditional ambulatory surgery centers. - The safety argument rests on big real-world datasets — about 21,500 Kaiser Permanente office cases, 18,005 multicenter private-practice lens cases, and newer oral-sedation data. - It matters because office suites promise faster scheduling and lower friction, but only if practices can match ASC-grade standards.
Cataract surgery is turning into a fight over place, not technique. The operation itself is already fast, standardized, and common. The open question is where more of it should happen. John Hovanesian has been arguing that the next leg of the shift is toward office-based surgical suites — purpose-built rooms inside or attached to ophthalmology practices — because the workflow is tighter and the safety case is no longer thin. (crstoday.com) ### What is “office-based” here? This is not cataract surgery in a normal exam lane. The newer setups are dedicated surgical suites with sterile processing, air handling, electrical specs, and accreditation standards designed to look much more like a mini OR than a clinic room. That distinction matters, because a lot of the skepticism comes from people picturing a conversion that is far sloppier than what advocates are actually describing. (aao.org) ### Why are surgeons even pushing this? Basically — control and friction. In an office suite, the surgeon controls the staff, the schedule, and the patient flow. Hovanesian’s argument is that this can shorten the path from decision to surgery, cut down on extra coordination, and make the whole experience feel more continuous for patients because they stay with the same team i(aao.org)spondents used ASCs, 26% hospital outpatient departments, and 6% in-office suites, up 2 points from 2024. (crstoday.com) ### Where does the safety case come from? The strongest support is cumulative, not one blockbuster trial. The early large U.S. dataset came from Kaiser Permanente Colorado — 21,501 eyes in 13,507 patients undergoing office-based cataract surgery, with no endophthalmitis reported and no life- or vision-threatening intraoperative or perioperative adverse events in the published summary. That gave the field a(crstoday.com)use it happened outside an ASC. (pubmed.ncbi.nlm.nih.gov) ### What about private practices? That was the next gap. A later multicenter U.S. study led by Lance Kugler reviewed 18,005 office-based lens surgeries across 36 sites from 2020 to 2022. Reported complication rates were very low — postoperative endophthalmitis 0.028%, toxic anterior segment syndrome 0.022%, corneal edema 0.027%, unplanned anterior vitrectomy 0.177%, return to the OR 0.067%, and hospital referral 0.0(pubmed.ncbi.nlm.nih.gov)ng outcomes that match or beat published ASC-era benchmarks. (pubmed.ncbi.nlm.nih.gov) ### So where does the “110,000” line fit? Turns out that number is best understood as a broad real-world office-cataract evidence base, not a single landmark paper I could verify. The clearly documented published datasets I found are the 21,501-eye Kaiser study and the 18,005-case multicenter private-practice study, plus newer prospective oral-sedation work. Added together with registry experience and subsequent pra(pubmed.ncbi.nlm.nih.gov) and a much larger cumulative case pool — but the clean, citable peer-reviewed anchors are smaller than 110,000 on their own. (aao.org) ### Why does oral sedation matter so much? Because anesthesia logistics are half the battle. A 2025 AAO-presented prospective series from Philadelphia Eye Associates and Wills Eye followed office-based cataract cases done with oral diazepam rather than routine IV sedation. Only 10% needed supplemental sedation, none had to be rescheduled for IV sedation because of anxiety or (aao.org)ice model easier to run — fewer prep steps, less fasting burden, and less dependence on anesthesia workflows that were built for bigger facilities. (aao.org) ### What is the catch? The catch is that office-based surgery only works if the suite is genuinely built for surgery. Hovanesian himself is notably not saying every practice should flip tomorrow. He says the move makes the most sense when a practice lacks an ASC, faces certificate-of-need barriers, or has a specific cost, access, or throughput problem to solve. If a practice already has a well-run ASC, the incentive is weaker. (crstoday.com) ### Bottom line? This is not really a story about whether cataract surgery can be done safely in an office. The field has largely moved past that binary. The real debate now is which practices can reproduce ASC-grade systems inside office walls — and whether the payoff in speed, control, and patient convenience is worth the build. (crstoday.com)
