Local doctors pioneered outpatient eye surgery in Ohio.

Local doctors pioneered outpatient eye surgery in Ohio.

Outpatient eye surgery facilities now dot Ohio, but when the Columbus Eye Surgery Center opened 20 years ago this spring, the state had never seen anything like it.

Eye surgery was the exclusive province of hospitals, according to Richard Orlando, MD, an ophthalmologist and a founder of the center. The Ohio Department of Health required any proposed medical facility to prove its services were needed in the geographical area where it intended to open-the so-called "certificate of need" requirement.

Hospitals objected if a proposal seemed to duplicate what they already offered. The certificate of need and the potential of a hospital challenge kept independent medical groups from trying an outpatient surgery center-that is until Orlando and his co-founders, Robin Beran, MD and Robert Bruce, MD came along.

"It was a huge risk," says Orlando. "But that's how much we believed in it."

Arizona and Florida, states with large retirement-age populations in need of eye surgeries, proved that outpatient centers work. A 15-minute cataract procedure didn't need to be in a hospital. Infection rates stayed low for outpatients, and patient satisfaction was high, Orlando says.

The streamlined approach of an outpatient center could have people back in their own homes in a few hours. And without overhead costs of a hospital, outpatient eye surgeries saved money for patients, Medicare and insurance companies.

Orlando and his co-founders foresaw another benefit. They were operating in a Grant Medical Center building and were asking their predominately-older patients to make the nerve-wracking drive Downtown in the early morning. Less traffic and more parking would help everyone.

The ophthalmologists decided on the Far East Side, where no other eye surgeons who regularly performed these procedures were working and Mount Carmel East Hospital's close emergency room could give nervous patients a little peace of mind.

The first eye-only surgical center in Ohio opened on March 18, 1996.

"I was excited from day one," says Karen Georgia, a registered nurse and one of four people still on staff from that first day. "We deliver the utmost in patient care. We're really able to dial in on the needs of the patient."

The founders learned it was safe for patients to wear their own clothes during most procedures, in place of the traditional hospital gown. Instead of moving them from wheelchair to hospital bed to recovery bed, Columbus Eye Surgery Center kept patients in a single gurney from beginning to end.

Medical innovation mattered, too. Bruce, now retired, performed the first outpatient retina surgery in Ohio at the center. Patients with long-term diabetes may develop diabetic retinopathy, or damage to a part of the back of the eye. Those patients are sicker than most others, and so special protocols must be followed to ensure they are safely cared for in an outpatient setting.

"Dr. Bruce helped design a lot of protocols that are standard today when treating diabetics," says Orlando. "We learned to adjust insulin dosage in the morning because the patient isn't eating. We check blood-sugar levels in the recovery room…Everybody does things this way now, but he was the first."

The doctors at Columbus Eye Surgery Center also worked with engineers from Storz Opthalmic, now part of the eye health company Bausch & Lomb, to design a single surgical machine that could perform certain retina and cataract surgeries.

Before that, two machines were required-along with more space, more training and more supplies. Outpatient centers were looking for efficiencies, and Storz approached Columbus Eye Surgery Center for help.

Ohio's certificate of need requirement was phased out in the late 1990s, opening the way for a boom in outpatient surgical facilities. In 2011, Columbus Eye Surgery Center sold a partial stake to Nashville-based AmSurg Corp., an operator of outpatient surgical centers around the country.

"They can negotiate on drugs that we use, or lenses, or a new microscope," says Orlando. "Vendors tend to pay a little more attention to them than if one place in Columbus, Ohio, is asking."

The focus on people is the same, though. Melissa Berry, OD, a Reynoldsburg optometrist, refers her patients who need surgery to the doctors at Columbus Eye Surgery Center. The center has the latest technology, and she's never been concerned with the medical treatment provided, she says.

But as a patient herself-she had her own cataract surgery there-what she most appreciated was how she was treated. "Dr. Orlando and the other doctors have access to this wonderful center, but they're also just caring people," Berry says.

Jeb Phillips is a freelance writer.