The Retina TL;DR: Redefining office-based surgery for retina care with Jonathan Feistmann, MD

Like what you just watched? The goal of The Retina TL;DR video series, hosted by Christina Y. Weng, MD, MBA, FASRS, is to provide fast-paced high-level information for today’s modern retina specialist. We’d love to hear your feedback. Email us at eyecarenetwork@mjhlifesciences.com

In this episode of The Retina TL;DR, powered by Modern Retina, host Christina Y. Weng, MD, MBA, FASRS, welcomes Jonathan Feistmann, MD, a retina specialist and an owner of the office-based surgery (OBS) facility at NYC Retina in New York, New York, for a discussion on factors for implementing an OBS for retinal procedures. Weng is professor and the Alice R. McPherson Retina Research Foundation Chair in Ophthalmology, and fellowship program director, vitreoretinal diseases and surgery with Baylor College of Medicine in Houston, Texas.

When asked to describe his mission in a "TL;DR" ("too long; didn't read"), Feistmann said "the reason why I do retina surgery in the office is because I'm trying to shorten the time to surgery for retinal detachments."

Feistmann explained that the motivation for OBS is to reduce delays in treating retinal detachments, “The goal is really to get patients treated as quickly as possible.” Rapid intervention is crucial to prevent vision loss and distortion, especially in urgent cases where hospital operating room access is limited.

Role of staff and implementation

The success of OBS relies on a highly trained, motivated staff, Feistmann continued..

“Having a dedicated team makes it possible to do this safely and efficiently,” Feistmann noted, highlighting the collaborative effort required to operate anytime, including weekends, holidays, and emergencies. Almost all retinal surgeries can be performed in-office, with exceptions only for very ill or anxious patients, he said. The procedures themselves are similar to intravitreal injections, using subconjunctival and posterior sub-Tenon anesthesia, and patients rarely need oral sedation. Retrobulbar blocks are avoided due to safety and legal concerns.

Safety considerations

OBS is considered very safe, as major ophthalmology risks usually stem from intravenous anesthesia, which is largely avoided. Posterior sub-Tenon blocks carry minimal risk, and systemic complications are rare. Patients are closely monitored, and anesthesia is carefully tailored to ensure comfort.

Patient experience and benefits

While retinal surgery is not highly profitable, Feistmann noted that OBS improves efficiency, reduces stress for both staff and physicians, and allows same-day intervention, bypassing delays associated with traditional hospital operating rooms.¹

He emphasized patient satisfaction, saying, “Patients are often surprised at how comfortable and quick the procedure is.” Faster access to care not only alleviates anxiety but also significantly reduces the risk of vision loss.

Additional resource

For surgeons interested in bringing office-based surgery to their practice, Feistmann pointed to Office-based surgery: our first 700 cases, which was published in the Summer/Annual Meeting 2024 issue of Retina Times.

Christina Y. Weng, MD, MBA, FASRS, is professor and the Alice R. McPherson Retina Research Foundation Chair in Ophthalmology, and fellowship program director, vitreoretinal diseases and surgery with Baylor College of Medicine in Houston, Texas. Weng has no relevant disclosures.

Jonathan Feistmann, MD, is a retina specialist in private practice with NYC Retina in New York, New York. He is an owner of the OBS facility at NYC Retina.

REFERENCE

1. Feistmann J, Busquets MA. OR Access Town Hall. Presented at: American Society of Retina Specialists 2025 Business of Retina Meeting; March 28-30, 2025; Atlanta, Georgia.