The Impact of Preloaded Intraocular Lens Implantation System (TECNIS iTec®) in Routine Cataract Surgery in China: A Time-Motion Analysis (Preprint)
Authors: Song Xudong , Zhou Jian , Zhang Guangbin , Jia Songbai , Yuan Jun , Hu Ke , Liu Xinhua , Zeng Mingbing , Wang Zhenyu , Tan Baoying , Lu Xingwei , Lin Ailing , Hu Xiaohan , Xuan Jianwei 
Published: May 2022

BACKGROUND

Age-related cataract is an age-related lens opacity disease, which ranks first in the world as a major cause of blindness. With the increase of age, the number of patients with age-related cataract continues to grow as currently observed in China.Traditional manual IOL need to be installed under a microscope or naked eyes using tools, such as folding clips and implants, before implantation. A study showed that when using manual IOL, the mean number of IOL physical touch of surgery equipment in each cataract surgery was 4 to 5. When physician’s assistant or nurse is not skillful in the preparation, wrong installation may occur. At the same time, the loading process increases the time of operation and the risk of IOL contamination, which may lead to various complications, including anterior segment toxicity syndrome, endophthalmitis, severe intraocular tissue injury and severe vision loss or even blindness.

OBJECTIVE

To evaluate the impact on surgical efficiency and labor time cost of preloaded intraocular lens (IOL) implantation system compared with manual IOL implantation system in age-related cataract surgery in China.

METHODS

This study was an observational, multicenter, prospective time-motion analysis. IOL preparation time, operation time, cleaning time, number and cost of cataract surgeries in eight participating hospitals were collected. The linear mixed model was used to explore factors associated with the difference in operation time between the preloaded IOL implantation system and the manual IOL implantation system. A time-motion model was constructed to convert the operation time cost saved by using preloaded IOL into economic benefits from hospital and social perspective, respectively.

RESULTS

There were 2,591 cases included in the study (preloaded IOL: 1,591 cases; manual IOL: 1,000 cases). The preloaded IOL implantation system was significant time-saving in both preparation time and operation time compared to the manual IOL implantation system (25.48s vs 47.04s, P < 0.001 and 353.84s vs 367.46s, P = 0.004, respectively). An average of 0.586 minutes can be saved by using preloaded IOL per procedure. The results of linear mixed model showed that the type of IOL was the main factor leading to the difference in preparation time between preloaded IOL and manual IOL implantation system. By switching from manual IOL to preloaded IOL, the model projected additional 392 surgeries can be performed each year and an increase in revenue of $565,282 per hospital, a 9% increase from hospital perspective. And the annual productivity loss saved by using preloaded IOL was $3,006 in eight hospitals from perspective of society.

CONCLUSIONS

Compared with manual IOL implantation system, the preloaded IOL implantation system reduces lens preparation time and operation time, which increases potential surgical volume and revenue, and reduces the loss of work productivity. This study provides real-world evidence to support the advantages of the preloaded IOL implantation system in improving efficiency of ophthalmic surgery in China.