Author: cvanassche

Getting Back To Practice With All The Tools You Need

[Webinar Recording] – Getting Back To Practice With All The Tools You Need

 

Brought to you by Advancing Eyecare.

How do you maintain social distancing even as your practice opens up again? Whether you’re a current Marco user or a doctor looking into the latest tools, Marco technologies can provide important patient safety measures in a post COVID-19 era. A panel of doctors share their stories with digital refraction and slit lamp imaging that enable safe social distancing, minimize patient / doctor / staff exposure with flexible configurations, and facilitate remote exam capabilities with new software. Automated refraction offers the ability for a comprehensive, efficient, and safe exam. We’ll also discuss software optimization to see more patients in less time, patient retention, and more.

FEATURING:

Laurie Sorrenson, OD, FAAO
Lakeline Vision Source
Cedar Park, Texas
“When the coronavirus started happening, I was really grateful that we had the technology. Creating that additional space from the doctor to the phoropter while you’re doing the refraction feels a whole lot safer. We can also take the unit and move it farther away from the patient and you can quite easily create that 6 foot distance in our space. Increasing the safety for my doctors when they’re seeing patients and increasing the patient’s safety is huge.”
Eric Hammond, OD
Lakeline Vision Source
Cedar Park, Texas
“A lot of people think you will lose the personal touch doing exams from a different room.  But now more than ever I think patients are more appreciative of it.  During emergency visits, not only have I have found that patients appreciate that we are open but are even more appreciative of the extra protective steps we have taken.”
Coby Ramsey, OD
Ramsey Eye Care Center
Rock Springs, Wyoming
“When COVID erupted we still wanted to be efficient and thorough, and we also wanted to be safe.  We were able to add four to eight comprehensive eye exams in a day, which is huge.  Doing refraction in a very quick amount of time.  Looking ahead, we will be swamped when we get back to full time practice and we will need to be extremely efficient and even more aware of safe practices.”

WEBINAR RECORDING:

How to Establish Safe Boundaries During a Comprehensive Exam

Marco ‘COVID-19 Ready’ Exclusive Offer

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Limited Time ‘Back to Practice’ COVID-19 Ready Offer

Benefit from safe social distancing (even from the next room or remote location) while giving a comprehensive refraction exam

Exclusive Offer Details include:

– Marco Automated Refraction System Package
– Instant $2,000 COVID-19 Rebate
– Infinity Remote Operation Software ($5,000 value). Zero subscription fees.
– Exclusive financing program

FINANCING: 0% DOWN WITH 6 MONTHS DEFERRED PAYMENTS

Click here to get more information

Offer available now through May 31, 2020.

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Request a Free Breath Shield for your Marco Slit Lamp

The health and well-being of our employees, customers, and their patients is our top priority. We realize this health situation has already been disruptive to many businesses across the globe and we are here to support you in any way that we can. We are offering free breath shields for customers with Marco slit lamps* to help prevent the spread of COVID-19 and other infectious diseases.

Click here to Redeem your Breath Shield

*While supplies last. Offer available for Marco slit lamps only. Limit one per customer.

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Introducing the Advancing Eyecare Webinar Series

Our team is constantly monitoring the COVID-19 situation. We conducted a survey recently and we want you to know that we’ve analyzed the results and have come up with a series of educational events based on your feedback.

Join us for one our free webinars, or register for an on-demand webinar that fits your schedule.

Click Here to see the Topics, Schedule, and Sign Up!

 

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The Power of “Wow”

Our practice, Virginia Eye Consultants, is a tertiary care referral practice specializing in cornea, refractive, uveitis, retina, glaucoma, and oculoplastics. We firmly believe in collaborative care, and we work closely with the optometric community. Recently, our practice celebrated our 50th anniversary providing world-classspecialty eye care to our Hampton Roads community.

We house 17 providers, including 13 ophthalmologists, 4 optometrists, and 225 support team members, and we perform in excess of 5,000 surgical procedures annually, with the majority being cataract surgical procedures. We have four locations throughout the Hampton Roads area, with our main office located in Norfolk, VA, and three satellite offices located within 30 minutes of each other.

Several years ago, we made one of our best strategic and business decisions when we acquired Marco’s EPIC-5100 for our main office. This is where the majority of our providers are based and most of our cataract and refractive evaluations are performed.

The EPIC-5100 combines two of Marco’s most advanced visual pathway assessment technologies: the OPD-Scan III wavefront aberrometer and corneal analyzer and the TRS-5100 digital refractor. The two technologies can be used together to evaluate the entire visual system in a fraction of the time it takes traditional manual systems.

Indeed, we chose the EPIC-5100 system specifically to address and improve our patient throughput and efficiency, and we couldn’t be more pleased. To say the EPIC-5100 has improved our performance in this area would be an understatement. The majority of our patients are referred to us for cataract and refractive surgery from our optometric referral network. Utilizing this technology has improved our efficiency through the technician workup alone.

Prior to implementing the EPIC-5100, our technicians took nearly 40 minutes to perform a patient workup, gathering data from visual acuities to topography to refractions. In the time since we’ve acquired the EPIC-5100, we have been able to get the same amount of data in just 15 minutes, allowing us to improve both efficiency and overall time for cataract/refractive evaluations.

The user-friendly platform enables technicians to quickly gather the critical data that are used to determine each patient’s optimal treatment, whether that is for cataract or refractive surgery. A wealth of information critical to each patient’s visual system from the refraction — wavefront measurements, pupil size, angle kappa, and corneal topography — is gathered swiftly and efficiently using the EPIC-5100. The EPIC-5100, combined with the OPD-Scan III, can give us more than 20 measurements to utilize in our decision making. Even better, all of the data can be captured in about 10 seconds.

Additionally, we have an OPD-Scan III at each satellite location, which allows us to gather the clinical information necessary to make our recommendations.

Patients and Practitioners Both Benefit
The decision of whether or not to adopt new technologies can be challenging. However, when it comes to innovative technology such as the EPIC-5100, the decision was easy for us. From the “wow” factor to patient education to informed clinical decision making, patients and practitioners both benefit from the EPIC-5100 and the OPD-Scan III.

Our biggest challenge prior to adopting the EPIC-5100 was patient wait times due to bottlenecks resulting from lengthy patient workups. As in any practice, patient wait times play a significant role in the patient experience, and it is important to continuously evaluate our practice processes and procedures to optimize care. With the Marco products, we are able to utilize the technology to improve throughput as well as the staff and patient experience.

The EPIC-5100 and OPD-Scan III technology differentiate our practice and provide information we can share with our patients. It gives them the confidence that they’re in the presence of state-of-the-art technology that will be used to determine which procedures and surgeries are best for them. We measure patient satisfaction with surveys after each visit and gauge the patient experience by using the Consumer Assessment of Healthcare Providers & Systems survey; they show definitively that patients believe they’re receiving the care they need and deserve. Each survey provides different information about the experience they had and the level of satisfaction with their care.

Enhancing Patient Education and Experience
Regardless of the condition for which a patient presents, patient education is key to successful outcomes. With the OPD-Scan III, we have the ability to educate patients about the impact on the ocular surface using the placido rings from dry eye to pterygium to other corneal surface irregularities. We can use the topography maps to discuss either the normal or abnormal corneal curvature, which shows why patients may have compromised vision and what we can do to address the condition.

Another feature of the OPD-Scan III that we take advantage of to educate our patients is simulating their vision before or after correction. In a practice like ours, this is turning out to be a vital tool in helping patients recognize the benefits of a new refraction, contact lens prescription, or surgical procedure.

As an optometric referral center, our practice’s success and growth is focused on patient experience and outcomes. The “wow” factor experienced by the patient while going through testing as well as our ability to minimize wait times and the amount of time patients are seen for their cataract/refractive evaluation determines our success. The information the technology provides give us the ability to make a solid recommendation for treatment.

Marco has been a great partner with our practice in providing the support and resources we need to successfully implement and utilize their technology. From the initial training for the staff to the support for providers on how to understand and utilize the technology, Marco has truly helped us to maximize the technology in daily practice.

Innovative Technology Is Key to Success
It’s also worth noting that implementing innovative technology is a key way to help differentiate your practice, prepare it for the future, and, perhaps most importantly, protect it against competition of all kinds. Online refractions, for example, provide limited data with questionable reliability. Technologies, such as the EPIC-5100 and OPD-Scan III, however, provide an unmatched experience and information that patients simply can’t get online.

With changes in optometry due to supply and demand in eyecare providers, optometrists will be called upon to provide more medical eye care for our patients and communities. The EPIC-5100 and the OPD-Scan III can aid providers in gathering reliable data in an efficient manner while allowing us to concentrate on our patients’ medical needs, such as diabetes, glaucoma, and cataracts, something the online competition cannot do.

Optometrists would do well to recognize these benefits and respond accordingly.

– Walter Whitley, OD, MBA, FAAO, is the director of optometric services at Virginia Eye Consultants, which serves the Hampton Roads region of Virginia.

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We want to hear your questions, advice, and concerns.

Most practices are understandably concerned about the spread of the virus and its effect on their business. As the situation changes daily, we want you to know that we are here for you and our team is constantly monitoring the situation.

We are conducting a brief (5-10 minute) survey to hear how you’re dealing with the global pandemic. We want to hear your questions, advice, and concerns.

Stay tuned for future webinars and articles to share best practices recommended by your peers and to help alleviate some of your concerns.

Click Here to Take the Brief Survey

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TRS-5100: A Win-Win

In using a manual refractor, I was facing two major and increasingly burdensome challenges. First, the technology was simply outdated compared to all the other technology I have in my practice, such as the OPD-Scan III (Marco), digital retinal photography, OCT, osmolarity testing, Visioffice, and my EMR system. Simply put, the refractor did not complement the level of care and patient experience I was providing throughout the rest of the examination and beyond, including the various touch points I have with patients through electronic media.

The second major challenge I faced was the inefficiency associated with manual refraction. I work just 3 days a week, so I need to maximize efficiencies to best serve my patients and my practice. The several extra minutes it takes for a traditional refraction really adds up, especially in a practice with patient volume averaging about 15 to 20 patients per day. I would prefer to spend that valuable time educating patients and making recommendations about eyewear and ocular health.

I reviewed auto-refractor systems from other companies, but I ultimately went with Marco’s digital technology because of their established success and consistency. Further, I received many strong recommendations from other doctors who successfully use Marco refractive technology in their own practices.

My selection of the TRS-5100 has proven successful in addressing my issues of compatibility, consistency, and efficiency. The system has improved the overall efficiency of the practice, and its compatibility with the OPD-Scan III wavefront aberrometer has proven to be invaluable. Combined and integrated with the OPD-Scan III, the TRS-5100 gives me a much better idea of a patient’s likelihood of achieving 20/20 vision, and a far more comprehensive picture of the patient’s complete optical pathway.

The OPD system delivers a statistical indicator (RMS, or root mean square), which gives the practitioner an idea of potential best-corrected outcome. This statistic is obtained via aberration measurements, topography, pupil sizes, and day and night refraction differences, among other data points. As a result, I know about how long I should spend refracting my patient with the TRS if his potential visual outcome is limited. I generally save several minutes per patient, and several minutes more on patients with more complex refractive errors (i.e., patients with moderate to advanced cataracts and corneal irregularities).

Positive Staff and Doctor Impact
My staff quickly embraced the system. They appreciate its ability to free them up for other tasks. The automated data transfer through the IC card-loading system minimizes staff involvement, as the patient’s refractive data is loaded onto a data card in the pre-test area, and the card is inserted into the TRS module in the exam lane, loading all data instantaneously. Staff members no longer have to enter refractive data, which saves time and reduces costly transcription errors.

As for myself, I really appreciate the system’s customizable ergonomic preferences. Although I see patients only three days per week, the upper shoulder and back strain I suffered prior to acquiring the TRS-5100 was nearly
constant. I’m sure other ODs who have used manual refractors can relate. Today, I have far less upper shoulder pain and back issues, thanks to the system’s ergonomics — ergonomics that may actually lengthen my career.

Positive Patient Response
The patient response to the new system has been overwhelmingly positive, both within and outside our practice. New patients and those unfamiliar with the system hear the TRS-5100 uploading data as they sit in the exam chair and are excited to see how it works, even before I start refracting. Patients who pay attention to medical technology can immediately appreciate how advanced our practice is compared to others.

Indeed, the system provides a true wow factor with patients. The TRS-5100 allows for a one-touch comparison of the patient’s current eyeglass prescription with the new prescription. Patients can immediately see for
themselves — in vivid detail — the impact of updating their prescription. While the previous processes left a fair number of patients uncertain about whether or not to purchase new eyewear — even with doctors’ recommendations — the TRS gives them far more confidence in their purchasing decisions, and applies more value to our practice.

Outside the office, my practice is enjoying many more positive online reviews, and our online referral stats are up by about 100% compared to the year prior, when we didn’t have the TRS. In addition, the comments from patient surveys now cite our technology, our professionalism, and the comprehensive, thorough nature of our eye exams as positive attributes in the patient experience.

Positive Financial Impact
In all honesty, except for the refraction, our exam flow hasn’t changed dramatically, so the transition was painless. I believe it’s the additional time I get to spend with and educate patients — enabled by the automation of the TRS-5100 — that is responsible for the favorable patient impressions. Thanks to this technology, I have more time to prescribe and recommend eyewear and contact lenses, and discuss treatment plans and general eye health with patients. All of this, of course, benefits our practice’s bottom line. Revenues-per-patient are already up about $50 over the previous year, and our capture rate in optical is up 10% since purchasing the TRS-5100. This automation further delivers a reduction in manual transcription errors and the cost of prescription remakes.

Bottom Line
With respect to improving exam flow efficiency and patient care, competitive standing among local optometry practices, and practice profitability, there’s simply no reason not to consider improving your practice with the TRS-5100. We are told to make purchasing decisions based on the goals of enhancing data, knowledge, profitability, and our care of patients. Marco’s TRS-5100 not only helps us meet all of these goals, it also makes our workday easier and far more pleasant. It’s a win-win for ODs and patients.

– Gina Wesley, OD, owns and operates Complete Eye Care of Medina, Medina, MN.

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Achieve Results and Manage Expectations

It is my belief that an excellent postoperative patient result begins with detailed attention to preoperative testing. With its diverse pre- and postoperative evaluation capabilities, the OPD-Scan III has improved my surgical outcomes and has increased overall patient satisfaction. Furthermore, I use the images on the OPD to discuss diagnoses and treatment plans with patients.

Pre-op Screening for Optimal Post-op Results
To achieve the best postoperative results, we must screen patients preoperatively to identify certain corneal disorders that may affect outcomes. The OPD-Scan III measures a large amount of data, all of which are helpful in determining the best treatment options for patients. We are constantly finding new ways to maximize its advantages. The OPD has led to reduced postoperative issues and complaints by helping me to properly select those patients who would be good candidates for premium IOLs.

For example, the OPD identifies corneal diseases — such as irregular astigmatism, higher-order aberrations (corneal coma or corneal trefoil), high or low spherical aberration, and visually significant pterygiums with irregular astigmatism extending into the central pupillary zone. In each of these situations, the patient would be considered a poor candidate for a multifocal IOL.

I also evaluate the placido rings to look for irregularities. Irregular placido rings can be caused by a wide variety of corneal diseases, including dry eye disease, pterygiums, keratoconus, Salzmann’s nodules, corneal scarring, and epithelial basement membrane disease. If I decide to treat the corneal disease prior to cataract surgery, I obtain a repeat scan after surgery to show patients the subsequent improvement in the placido rings. This helps demonstrate the benefits of having an additional surgery prior to cataract surgery.

The OPD is especially helpful for identifying subtleties of dry eye preoperatively that I may not have otherwise noticed. It is easily seen as irregular placido rings, which can be shown to patients for educational purposes. From there, we begin a more thorough dry eye evaluation. After treating the dry eye disease, I repeat the preoperative testing and IOL calculations. Always address dry eye disease before surgery.

In addition, I evaluate all patients who have had previous LASIK, PRK, or RK. I am looking for irregular astigmatism, high spherical aberration, or a decentered ablation. I discuss these findings with patients preoperatively, explaining that prior refractive surgery may affect their final postoperative result, and because of this, it is possible that not all glare or decreased contrast sensitivity problems will be resolved.

The OPD also measures corneal spherical aberration, which allows me to customize my choice of IOL to best correct it. This helps to optimize each patient’s postoperative visual outcome.

Pre-op Screening of Premium IOL Patients
The OPD is especially valuable when evaluating patients who are interested in a toric IOL. The axial map is useful in confirming the planned axis for the orientation of the toric IOL, which should be very similar to the axis obtained via optical biometry. If the axis from the axial map and optical biometry are not similar, I repeat testing and look for the previously mentioned corneal disorders.

The OPD-Scan III also assists me in the multifocal IOL decision-making process. When evaluating multifocal patients preoperatively, I look for corneal disease. In general, the more irregular the cornea, the less likely I would be to use a premium IOL. For example, if a patient has significant higher-order aberrations, I would not use a multifocal IOL. In addition, I evaluate the mesopic and photopic pupil size. If the mesopic pupil size is greater than 6 mm, I have a discussion with the patient about an increased risk for halos and glare postoperatively. However, if the patient has a small photopic pupil less than 3 mm, I generally use a multifocal IOL in which the near vision isn’t dependent on pupil size. I also use the OPD to evaluate angle kappa. If angle kappa is greater than .43 mm, I use a multifocal IOL with a larger central zone.

Consistent Results with Post-op Screening
I obtain postoperative OPD-Scan III studies on all of my multifocal patients. Approximately 1 week after surgery, I obtain a dilated reading. This allows me to see if the central zone of the IOL is centered within the visual axis of the patient. If not, I know the IOL has shifted postoperatively, which frequently results in patient complaints of decreased vision and glare. Complaints usually can be resolved by surgically repositioning the multifocal IOL onto the visual axis.

I will also perform an OPD scan 1 week post-op on patients who received a toric IOL. Again, the scan is obtained with a dilated pupil. In this way, I can measure the axis orientation of the toric IOL to ensure that the toric IOL didn’t rotate away from the intended axis of surgical orientation. Correct toric alignment is critical because the power of the astigmatic correction is reduced 10% for every 3 degrees away from the intended axis of orientation. If there is significant rotation of the toric IOL, I will take the patient back to the OR to realign the toric IOL to the proper orientation.

More Information = Happier Patients
The OPD-Scan III has significantly reduced the number of post-op complaints from patients. With more information to guide me through the entire process, I’ve been able to largely avoid unhappy multifocal IOL patients by identifying the best candidates up front. Before we acquired the OPD, we were inconsistent when making these pre-op decisions.

Making the right decision as a surgeon is only one component of meeting or exceeding patient expectations. It’s also important that I educate patients at each step along the way. Pre-op tests help me manage expectations by educating patients with the aid of easy-to-understand test results. Visual aids help explain variables to improve patient understanding. For example, using OPD results, I can show a patient that his lens is well centered and his toric IOL is well positioned. Patients can see irregular placido rings consistent with dry eye syndrome, which reinforces the need to treat their dry eye prior to surgery.

Imaging can also show patients why irregular astigmatism may prevent them from being premium IOL candidates. With this information and education, patients better understand why you’re making certain decisions, they recognize that you’re trying to make the best decision for them — and they appreciate that.

Customization = Efficiency
The varied capabilities of the OPD allow us to create a specific map for pre- and post-op testing to meet the needs of each patient. We created a customized map to include all the important information we need to preoperatively evaluate the patient. By consolidating all the important measurements on one map, pre-op patient evaluations are much more efficient and allow us to create a personalized treatment plan for each patient. It’s amazing how many options there are with this instrument. We have customized it for our needs, and certainly other offices can adjust their maps to accommodate their needs as well.

We have also developed a comparison map to evaluate pre- and post-op LRI data to evaluate femtosecond laser LRI treatments. The outcome analysis can be used to adjust your LRI nomogram for any under-correction or over-correction of astigmatism. You may also use the comparison map to look for any increase or decrease in higher-order astigmatism, which may occur after an LRI.

Improve Satisfaction and Results
We acquired the OPD-Scan III about 5 years ago in an effort to improve our outcomes and patient satisfaction. It has delivered by helping us to preoperatively detect corneal issues that may affect outcomes, identify the best candidates for premium IOL surgery, improve surgical outcomes, and increase patient satisfaction.

– Dr. Ludwick specializes in cataract surgery and is the Medical Director at Ludwick Eye Center, with locations in Maryland and Pennsylvania. He is also an assistant clinical professor at Penn State Hershey Medical Center

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Marco Invites You to VEE 2020 For Free!

Join Marco in New York City from March 26-29 for the complete event for ophthalmic professionals. Register for FREE exhibit hall admission as our guest and visit us in booth #MS4803.

2020 is coming, and so is the future of Vision Expo. Curated neighborhoods and elevated experiences are the focus as Vision Expo continues to lead the industry as the pinnacle event for ophthalmic professionals. Explore the latest in technological innovation and hone your craft in our education center with more than 300 hours of accredited seminars, workshops and presentations. Be where eyecare meets eyewear, education, fashion, and innovation, and immerse yourself in the future of the industry as we take our first step towards building for tomorrow.

We hope to see you at Vision Expo East 2020 in our booth #MS4803!

To register, click here or go to: http://visionexpoeast20.nvytes.co/vee20/register/CIP56.html 

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Better Information, Better Outcomes

I purchased the original OPD-Scan 8 or 9 years ago, and upgraded to the OPD-Scan III in December 2014. The original OPD-Scan was an absolutely spectacular piece of equipment, and the OPD-Scan III was enough of an improvement that I thought it was worth my while to make the investment. After more than a year, I am confident that I was right.

Better Delivery of Information
The OPD-Scan III is clearly an improvement on what was already great technology. It provides much of the same useful information but in an improved format, and in an easier, more efficient manner. The OPD-Scan III has better resolution and interface, and provides useful, integrated summaries that weren’t readily available in the original model. For example, now my techs can easily obtain a cataract, cornea, diagnostic, or toric summary for me to review and make assessments.

Corneal Wavefront Integration
The ability of the OPD-Scan III to examine the corneal wavefront is a huge improvement, because it helps me to determine the best course of treatment, be it LASIK or cataract. It also helps provide an overview of the patient’s visual status and problems. Every LASIK or cataract evaluation patient has those scans done prior to me even walking into the room, so I have a vast amount of relevant information right in front of me. With better information, I am able to achieve better outcomes for both refractive and cataract patients.

Improved Decision Making
The OPD-Scan III makes my job much easier, and it helps me achieve the best possible outcomes. Let’s say, for example, a patient is in for cataract surgery. I can easily explain to the patient which lens I want to place based on the information that the OPD-Scan III provides. In addition, if I’m considering a multifocal IOL, I can evaluate the corneal wavefront aberrations and quickly make an educated decision as to whether or not the patient is a good candidate for a multifocal IOL, based upon the corneal aberrations that I’m seeing. Or, the information might help me realize the patient is a better candidate for a different lens. I can look at the topography and the regularity of the astigmatism in the corneal surface. The OPD-Scan III is also very good at helping to assess corneal astigmatism. I’m also able to help patients with less-than-perfect vision after cataract or LASIK procedures, whether performed by me or another physician, because data from the OPD-Scan III can help me figure out what is going on with the patient’s vision. It also allows me to see what astigmatism might be coming from inside the eye — either inside the lens and/or the posterior cornea. I have many referrals, complicated patients, or patients who are not seeing well after cataract or refractive surgery, and the ability to take all of these measurements and look at all of the various pieces of information often helps me identify the patient’s problem. This, in turn, helps me make a determination as to what is the right solution for the patient.

Technicians’ Seal of Approval
Because my technicians perform the tests with the OPD-Scan III, it is critical that my staff is proficient in using this technology. It is equally important to me that they like the equipment — and they do. My techs appreciate that the information from the OPD-Scan III is more detailed and the equipment is more user-friendly than the previous model; they have fully embraced its capabilities. And because the OPD-Scan III harvests more than 23 diagnostic metrics in 10 seconds per eye and provides so much integrated information, my technicians often will make a decision for a given patient as to what summary I might need, which is extremely helpful. Sometimes, I have to go back and ask for a different summary or scroll through different images, but that’s simply because there is so much information available at my fingertips if I need it.

An Office Favorite
If you’re looking to provide improved care for your cataract and LASIK patients, there is no question that the OPD-Scan III is worth the investment. The equipment is fantastic, and the customer service that Marco provides is remarkable. The support team comes in to help customize and set up the summaries that will best suit each office’s needs. They are always accessible and helpful. There are many pieces of equipment that I have and love, and I could probably get away with just using them. But I wouldn’t be seeing the whole picture concerning each patients’ optical path. With the OPD-Scan III, I can obtain the basic information — and so much more. There are so many things that this piece of equipment can illuminate for me, that I’m sure I haven’t even scratched the surface yet. It’s my favorite piece of equipment and I can’t imagine practicing without it.

– Dr. Horn specializes in cataract and laser eye surgery at Vision for Life in Nashville, Tenn.

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