Impact of a Swept Source-Optical Coherence Tomography Device on Efficiency in Cataract Evaluation and Surgery: A Time-and-Motion Study

Figures & data

Table 1 Measurements Collected at Each Study Site with Pre-Defined Start and End Times

Locations Within the Practice	Device/Task	Measurement Definition	Measurements Collected at Each Site
			Site 1	Site 2
Clinic	SS-OCT w/ORT	Time from when the patient places chin on device until the technician says “we are all done, you can remove your chin”	✔	✔
	OLCR		✔	✔
	PCI		✘	✔
	SS-OCT		✘	✔
	Image-Guidance Reference Unit		✔	✘
	Ultrasound Biometer Set Up and Wait Time	Time from completion of optical biometry to when the technician applies the ultrasound biometer device to the patient’s eye	✔^A	✔
	Ultrasound Biometer Measurement Time	Time from when the technician applies the ultrasound biometer device to the patient’s eye until they have completed measurement	✔^A	✔
	Aberrometer Database Input	Time from when they start to engage the monitor until the Technician hits “save”	✔	✘
Surgical Laser Room	Femtosecond Laser Prep with Image-Guidance integration	When the technician touches the femtosecond laser monitor to start patient data import until the patient data entry is complete	✔	✘
	Femtosecond laser Prep without Image-Guidance integration	When the technician touches the femtosecond laser monitor to start manual patient data entry until the time the technician finishes entering the manual data	✔	✘
OR	Manual Marking	When the surgeon engages the patient until they cap the pen	✔	✘
	Image-Guidance Set Up	When the technician touches the image-guidance monitor until when the technician announces completion	✔	✘
	Image-Guidance Registration	When the surgeon initiates registration with the foot pedal until the machine says “Registration complete”	✔	✘

Notes: ^AUltrasound biometer data was collected at Site 1 but not utilized in the time efficiency model as it does not provide a real-world representation of biometry acquisition failure.

Abbreviations: SS-OCT w/ORT, swept-source optical coherence tomography (SS-OCT) biometer integrated with operating room technologies; OLCR, optical low coherence reflectometry; PCI, partial coherence interferometry; OR, operating room.

Figure 1 ^AUltrasound Biometer Wait + Set-Up + Measurement Time, when biometer acquisition failed.

Abbreviations: SS-OCT w/ORT, swept-source optical coherence tomography (SS-OCT) biometer integrated with operating room technologies; OLCR, optical low coherence reflectometry; PCI, partial coherence interferometry; OR, operating room.

Figure 2 ^AUltrasound Biometer Wait + Set-Up + Measurement Time, when biometer acquisition failed, ^BTime measurements applied only to patients receiving an advanced technology intraocular lens (IOL), SS-OCT W/ORT replaces the need for the Image-Guided Reference Unit for clinic to OR integration.

Abbreviation: SS-OCT w/ORT, swept-source optical coherence tomography (SS-OCT) biometer integrated with operating room technologies.

Figure 3 Patient enrollment and inclusion from both study sites.

Table 2 Average Acquisition Times by Biometer (SS-OCT w/ORT, OCLR, PCI, SS-OCT) for All Patients, and by Cataract Density [Study Site 1 and 2]

Biometer	All Patients				Dense Cataracts				Non-Dense Cataracts				P-value (Dense vs Non-Dense Patients)
	n	Acquisition Time^A [Minutes]		P-value vs SS-OCT w/ORT	n	Acquisition Time^A [Minutes]		P-value vs SS-OCT w/ORT	n	Acquisition Time^A [Minutes]		P-value vs SS-OCT w/ORT
		Mean	SD			Mean	SD			Mean	SD
SS-OCT w/ORT	210	1.01	0.29	-	91	1.08	0.36	-	117	0.96	0.21	-	0.0034
OLCR	210	1.58	0.42	<0.05	91	1.68	0.40	<0.05	117	1.52	0.41	<0.05	0.0038
PCI	188	1.71	0.43	<0.05	90	1.74	0.49	<0.05	98	1.68	0.37	<0.05	0.3776
SS-OCT	188	1.24	0.35	<0.05	90	1.32	0.41	<0.05	98	1.16	0.27	<0.05	0.0026

Notes: ^AThe mean difference among all the groups is significantly different (p<0.0001). Biometer measurement times reported for 5 scans per eye.

Abbreviations: SD, standard Deviation; SS-OCT w/ORT, swept-source optical coherence tomography (SS-OCT) biometer integrated with operating room technologies; OLCR, optical low coherence reflectometry; PCI, partial coherence interferometry.

Table 3 Acquisition Failure Rate by Biometer for All Patients, and by Cataract Density [Study Site 2]

Biometer	All Patients (n = 188)		P-value vs SS-OCT w/ORT	Dense Patients (n = 90)		Non-Dense Patients (n = 98)
	n	%		n	%	n	%
SS-OCT w/ORT	0	0%	N/A	0	0%	0	0%
OLCR	10	5.3%	0.004	9	10.0%	1	1.0%
PCI	28	14.9%	<0.0001	23	25.6%	5	5.1%
SS-OCT	5	2.7%	0.05	5	5.6%	0	0%

Abbreviations: SS-OCT w/ORT, swept-source optical coherence tomography (SS-OCT) biometer integrated with operating room technologies; OLCR, optical low coherence reflectometry; PCI, partial coherence interferometry.

Figure 4 Efficency Impact of an SS-OCT w/ORT in the Clinic Compared to OLCR per 1,000 Patients (Hours). ^AUltrasound Biometer Wait + Set-Up + Measurement Time was only collected when biometer acquisition failed.

Abbreviations: SS-OCT w/ORT, swept-source optical coherence tomography (SS-OCT) biometer integrated with operating room technologies; OLCR, optical low coherence reflectometry.

Figure 5 Efficency Impact of an SS-OCT w/ORT in the Clinic Compraed to PCI per 1,000 Patients (Hours). ^AUltrasound Biometer Wait + Set-Up + Measurement Time was only collected when biometer acquisition failed.

Abbreviations: SS-OCT w/ORT, swept-source optical coherence tomography (SS-OCT) biometer integrated with operating room technologies; PCI, partial coherence interferometry.

Figure 6 Efficieny Impact of an SS-OCT w/ORT in the Clinic Compared to SS-OCT per 1,000 Patients (Hours). ^AUltrasound Biometer Wait + Set-Up + Measurement Time was only collected when biometer acquisition failed.

Abbreviation: SS-OCT w/ORT, swept-source optical coherence tomography (SS-OCT) biometer integrated with operating room technologies.

Figure 7 Integration Capabilities of an SS-OCT w/ORT in Clinic Evaluation and Surgery Workflow Compared to SS-OCT per 1,000 Patients (Hours). ^AUltrasound Biometer Wait + Set-Up + Measurement Time was only collected when biometer acquisition failed.

Abbreviation: SS-OCT w/ORT, swept-source optical coherence tomography (SS-OCT) biometer integrated with operating room technologies.