AAO: Office-Based Cataract Surgery Study Shows Success With Minimal Oral Sedation
A new study presented at the 129th annual meeting of the American Academy of Ophthalmology (AAO) is challenging long-held assumptions about cataract surgery. The research demonstrates that patients can safely and successfully undergo office-based cataract surgery using only minimal oral sedation, rather than intravenous (IV) sedation typically administered in hospitals or ambulatory surgery centers.
At a time when artificial intelligence and robotics are reshaping the future of ophthalmic surgery, this study suggests that the next major shift may come from where and how cataract surgery is performed.
The research, led by Brad H. Feldman, MD, and colleagues at Philadelphia Eye Associates and Wills Eye Hospital, prospectively analyzed outcomes in all patients who underwent cataract surgery with oral sedation in an office-based surgical suite. According to Dr. Feldman, the results exceeded expectations. Only 10 percent of patients required any supplemental sedation beyond the standard oral dose of diazepam—typically 5 mg for older patients and 10 mg for younger ones. Importantly, no patient required rescheduling for IV sedation due to anxiety or restlessness.
“Before launching our office-based surgical suite, I would have anticipated that more patients would require higher levels of oral sedation,” said Dr. Feldman. “The reality was quite the opposite.”
Over 99 percent of patients chose to have their second eye operated in the same office-based setting, despite an ambulatory surgery center being available less than half a mile away.
While multiple studies—including those led by Tsontcho Ianchulev, MD, MPH, at Kaiser Permanente and Lance J. Kugler, MD, across 36 private practices—have validated the safety of office-based cataract surgery, detailed evidence on oral sedation protocols in private practice has remained limited.
“We know that well over 100 private practices in the US have begun performing office-based cataract surgery, and the vast majority of these cases are done under oral sedation,” Dr. Feldman noted. “We wanted to share our center’s specific approach, as we believe it can help other ophthalmologists optimize their protocols.”
Dr. Feldman emphasized that office-based surgical suites are not merely converted exam rooms. His facility is accredited by the Joint Commission and constructed to meet the same high standards as ambulatory surgery centers—including specialized operating rooms, sterile storage and processing areas, dedicated air filtration systems, and medical-grade electrical specifications, according to an AAO news release.
A key benefit of oral sedation, according to Dr. Feldman, is efficiency and predictability. Diazepam’s onset aligns closely with the time required for pupillary dilation, allowing the surgeon to assess both the pupil and the patient’s sedation level before entering the operating room. When additional sedation is needed, an orally dissolving tablet containing midazolam, ketamine, and ondansetron can be administered quickly and effectively.
“Unlike with IV sedation, patients are not brought into the operating room until they’re adequately sedated. That makes sedation levels during surgery highly predictable," Dr. Feldman said. “By just my second day in the office-based suite, I felt confident that this setting for cataract surgery was better for most patients—in terms of comfort, convenience, and safety.”
Dr. Feldman and his colleagues continue to collect prospective data on all office-based cataract surgeries performed at their facility and encourage others to contribute to this growing body of evidence.
Two related instruction courses on office-based cataract surgery are scheduled during this week’s AAO annual meeting:
Sunday, 3:45–5:00 p.m. — Office-Based Cataract Surgeries: Legal and Practical Considerations (AAOE Instruction Course)
Monday, 9:45–11:00 a.m. — The Shift to Office-Based Cataract Surgery: Insights and Considerations From Surgeons With Varied Practice Profiles