As technology becomes increasingly important
in our day-to-day lives, it also creates opportunities to better care for our
patients. But are technological advances always good, especially when it comes
to our patients' eyes?
Of course, a huge issue for many of us these
days is refractive surgery. Are you among the O.D.s who've accepted it with
open arms? Has it become a mainstay of your practice � an option that you
discuss with all of your patients? Or, do you feel that refractive surgery is
still not quite perfected and you reflexively tell all of your patients that
they should wait, at least for now?
Somewhere in the middle
The reality is probably somewhere in between
the two extremes. For the overwhelming majority of patients, refractive surgery
has been a Godsend. If you co-manage or perform refractive surgery, you know
exactly what I'm talking about. Happy patients aren't just 20/happy, they're
ecstatic. Comments like, "this is the best thing I've ever done," and
the positive buzz that fills the waiting room when a successful patient returns
for follow-up are intoxicating. But what about the few who aren't so lucky?
If successful refractive surgery is a
life-altering experience, unsuccessful refractive surgery is even more so.
While the successful patient continues his life with a persistent smile and a
clear view of the world, the unsuccessful patient faces a blurred future and a
life with permanent damage.
As the medical director of Surgical Eyes
Foundation, a group created to help patients damaged by refractive surgery, I'm
immersed in the indescribable misery of these poor souls. It has changed their
lives and honestly, the experience has changed mine.
Positive about refractive surgery's
But instead of these encounters making me
anti-refractive surgery, I'm more positive about the possibilities than I've
ever been. Seem odd? Let me explain.
With a clarity that comes from age,
experience and years of reading science fiction, I know that in the future
refractive surgery will likely become more common than contact lenses are
Our future depends upon it
Few of us today realize that our
profession's future depends upon our acceptance of surgical vision correction.
Recognize that we're destined to become
refractive surgeons � in the sense that the ability to permanently alter a
patient's refractive state will become mainstream optometric practice. At some
point, I believe that all optometrists will have the authority to change our
patients' vision through medical or surgical interventions. The question is,
how do we ensure our place in this new technology while safeguarding our
First, make sure that every patient
understands that some risk is involved. For my patients, I consider a visit to
www.surgicaleyes.org an essential element of informed consent. With lawsuits on
the rise, you soon will too.
Select patients carefully. Make sure that
they're refractively, medically and perhaps more importantly, psychologically
appropriate for refractive surgery. The extra time you take beforehand will
save grief afterward.
Finally, support the co-management model.
Our detractors claim it adds unnecessary cost and complexity, but, really, it
adds another safety layer. Support cooperative surgeons and laser centers such
as TLC that uphold our vision and help us manage our patients.
Refractive surgery is certain to become a
part of optometry's future. For now, selecting patients carefully and choosing
our partners well are among the most important choices we can make.
If you'd like to contact Dr. Epstein via
e-mail, you can send your comments or questions to him at: