Issues in Ophthalmology

Issues in Ophthalmology

Issues 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.

These 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.