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Dr. Lars Freisberg, Tulsa Retina Consultants

How Navilas® Benefits a Private Practice

In this interview, Dr. Freisberg explains how Navilas contributes to better time management in his  practice, why it provides a better experience for his patients, and why laser suddenly is fun again.

Dr. Freisberg, what are the challenges of using laser for retinal procedures in a modern high-volume practice?

In our practice, we treat approximately 30 patients with laser photocoagulation per week. The core challenge is the time management with laser.

While we need to be as efficient as possible, we also want to offer the best experience for our patients. However, we are facing the challenge that often the diagnosis and plan for treatment is made, and patients want same day treatment because of travel and time-off issues. Or a more light or pain sensitive patient may prolong the treatment and therefore delay the daily schedule, because they may need retrobulbar anesthesia, which is time-consuming. This impacts our efficiency.

How does Navilas contribute to better time management?

There are three principal aspects how Navilas contributes to better time management in our practice: 

  • The Navilas is much more comfortable for patients.
  • Patient education is much easier.
  • We save a lot of time through automated documentation of the treatment.

How does “more comfortable” treatment with Navilas reduce delays? 

As pain perception with Navilas is much lower, it reduces the potential delay caused by patients who need a break, can only tolerate so much treatment or who are requesting retrobulbar anesthesia– especially in peripheral applications. Even light sensitive patients tolerate the treatment with Navilas nicely. In focal therapy, we also appreciate the time saved by treating without a contact lens.

Why does better patient education with Navilas contribute to more efficiency?

We consider education as a fundamental aspect of providing a better experience for patients. We need to give them confidence and knowledge about their treatment. So if you manage proper education, you’ll get more compliant patients. In many cases this education is difficult and time consuming. With Navilas, we only need to show the picture of the retina including all marks we applied. Following the treatment, we can show what was done.

How does digital documentation help you save time?

Another aspect for better time management is the documentation. To properly document a conventional treatment, we need to write down laser parameters, draw an image of the posterior pole and mark the treatment area. Doing this manually does not always give precise data. With Navilas, we simply print a PDF – and that’s it. Perfect documentation in less than 10 seconds. And in the near future we hope to directly add it to our EMR.

Following the introduction of Anti-VEGF, the use of retinal photocoagulation has declined. Do you think that Navilas is changing this trend? When do you use laser in your daily routine?

Actually, I would say that Navilas is not changing the range of indications. However, Navilas has the ability to increase the frequency of laser treatments when indicated. 

What I mean is: You would also treat “difficult” patients, rather than extending their anti-VEGF treatments. Imagine you have an extremely light sensitive patient. Based on the diagnosis and the clinical evidence, laser would be indicated. However, just applying an injection would be easier. Or you have a patient with two heavily leaking microaneurysms relatively close to the fovea. Targeting these with a conventional laser is extremely challenging, sometimes even dangerous, if the patient is not perfectly compliant at the slit lamp.

With Navilas, these cases suddenly become feasible to be treated with laser. In addition, there are other indications that simply had been too challenging and thus were left untreated – for example parafoveal leakage in CSCR. 

Another aspect, which contributes to more use of laser in daily routines is the training of physicians. With low numbers of focal laser treatments you have less experience with doing that correctly – an injection is easier. With Navilas, the physician is supported in executing the proper treatment. This is especially beneficial for younger residents who have not done lots of focal lasers before.

So, from your experience, what are the key points which justify the investment in the Navilas laser?

It‘s actually a number of different reasons. Safety and speed of laser application have played a major role in our decision to buy this laser. Patient education turned out to be another really important factor in our current practice situation.

And the last factor – a very odd factor – is fun. With the digital capabilities of the Navilas, laser suddenly is fun again. It is fun, because you can apply exactly the treatment you want. And at the same time, after just the first week of trial with about 30 Navilas procedures, the patient response was unequivocally positive. 

Dr. Freisberg, we thank you for your time.

Dr. Lars Freisberg of Tulsa Retina Consultants

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