Article Date: 11/1/2000

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 future

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 today.

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 patients' safety?

First, make sure that every patient understands that some risk is involved. For my patients, I consider a visit to 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:

Optometric Management, Issue: November 2000