Issues in Ophthalmology
that arise in any area of health care usually pose more ques-tions than
answers. In ophthalmology, the well-being of the patient physically,
emotionally, financially, socially, and spiritually can be at risk when vision
is threatened. Patients with a deteriorating eye condition often worry about
the impact that visual loss will have on their lives. As they experience visual
distortions, scotomas, or gradual visual loss, what was a vague worry can
become a con-suming preoccupation. The patient may equate a decrease in visual
acuity with a loss of independence. The loss of a driver’s license may force a
patient to relocate his or her home or give up or change careers.
vulnerable patients may be easy targets for unscrupu-lous practitioners, who
may offer unproven treatments, often at great expense to the patient who is
desperate for any treatment that may prove beneficial. Patients travel from one
physician to another in search of any treatment that may forestall visual loss.
For example, a patient with 20/200 vision may wrongly believe that there is
nothing to lose and will submit to invasive surgeries, only to end with a
visual acuity of 20/800.
Not all patients who are contemplating ophthalmic
surgical procedures are in great distress from a sight-threatening condition.
Increasingly, patients are encouraged by friends and family or even by
advertisement to have elective procedures such as refractive surgery. Patients
are enticed by the thought of being free of eyeglasses or contact lens.
Refractive surgery sites are springing up in shopping malls and offering
discounts and sales on procedures.
Some cataract surgeons remove cataracts before
there is a vi-sual deficit or with the full knowledge that such surgery may
offer no increase in vision. Patients should be counseled before such
procedures about the potential risk versus the potential benefit. Patients who
have an ongoing retinal problem, such as AMD, should be evaluated by both a
retinal expert and a cataract surgeon.