Ophthalmology takes conservative path, but LASIK and phaco popular in Chile

Estimates say 45% or more of ophthalmologists in Chile use phacoemulsification, far more than in neighboring countries in Latin America.

Like the nation’s health system, Chilean ophthalmologists say they tend to take a more conservative approach to medicine than their colleagues in other Latin American countries. While some nations have de fined themselves ophthalmologically as places unafraid to try new, even radical treatments, the Chilean ophthalmologists interviewed for this article report that rarely is a technique or drug used in Chile that has not been thoroughly and meticulously studied and evaluated.

“Chile is different from other countries in Latin America,” said Rodrigo Donoso, MD, an ophthalmic surgeon and assistant professor at the University of Chile in Santiago. “Medicine is very conservative, and Chile adopts new treatments, techniques and technology only once they have been proven scientifically. We offer only proven medical techniques that efficaciously treat patients with a minimum of mistakes.”

He also explained that because of the smaller population of Chile in relation to other Latin American countries, and the conservative character of the nation’s ophthalmologists, new technologies take longer to evaluate — the numbers of procedures are lower than in other countries. “We cannot evaluate new techniques by comparing thou sands of cases the way physicians can in Brazil, Argentina or Colombia,” he said.

Eye care in Chile is generally regarded as good, but significant challenges to ophthalmology remain. Dr. Donoso said glaucoma diagnosis and treatment tends to be late, after damage has already occurred. Vitreoretinal surgery is advanced only at a few public ophthalmology services and at private clinics. Cataract diagnosis, especially in the rural regions, tends to be somewhat delayed.

Cataract

However, for a nation that considers its approach to ophthalmology conservative, Chile is far ahead of other countries in Latin America in terms of the number of physicians who regularly use phacoemulsification. Forty-five percent or more of Chilean cataract surgeons use phaco, while the remainder rely on extracapsular cataract extraction. Industry estimates say that as few as 5% of physicians in Latin America as a whole use phaco. There are about 62 phaco machines in Chile. Public sector physicians typically perform between eight and 12 cataract procedures per month, while physicians treating private patients will treat between four and 12 per day. Most private sector physicians use phaco.

Cataract surgery is reimbursed by managed care, or paid for by private patients, at between US $500 and US $1,000 per procedure.

In most of Chile, there are no significant cataract waiting lines to speak of. Private insurance or privately paying cataract patients are treated immediately, while public sector patients in urban regions typically wait about 15 days for surgery. Public patients in the rural regions may wait 4 months.

There are about 510 ophthalmologists in Chile. About 420 of them be long to the national Chilean Society of Ophthalmology. Sixty percent of ophthalmologists practice in the capital city of Santiago. About 10% practice in Valparaíso and 12% in Concepción. The remainder are scattered across the nation.

The number of ophthalmologists is growing in Chile. Each year, about five retire or die, while 12 graduate from medical school.

The financial situation of Chilean ophthalmologists is on par with most European nations. Ophthalmologists earn between US $4,000 and US $10,000 per month, depending on the number of private patients they treat.

Refractive surgery

Again, despite the claim there is a conservative approach to ophthalmology, refractive surgery also is growing quickly in Chile. Rene Moreno, MD, a private practice refractive surgeon in Santiago, described the nation’s experience in refractive surgery.

“We have an interesting experience in the evolution of PRK [photorefractive keratectomy] and LASIK [laser in situ keratomileusis]. We began PRK in 1993 and LASIK in 1996. At the end of 1996, 20 refractive surgeons did 50% PRK and 50% LASIK. In the last 6 months, the same surgeons did 90% LASIK and 10% PRK, which shows that once we believe in a technology, we embrace it.”

Refractive surgery, Dr. Donoso said, has grown popular in Chile, particularly in urban areas, where there are now eight excimer lasers in full-time use. LASIK is the preferred technique, but PRK is used occasionally for patients with low myopia. Radial keratotomy, which had never gained widespread use in Chile, has been wholly abandoned.

Though proud of the overall low side effects and complication rates, one ophthalmologist said he would appreciate more freedom.

“The major challenge for Chilean ophthalmologists in the future is two-fold. We must keep up with advanced technology and have fewer restrictions for the use of different devices or different techniques, but at the same time, we must be careful that laws do not allow us to be exploited by companies interested in testing new but potentially unsafe devices, equipment or drugs,” Dr. Moreno said.

For Your Information:

Rodrigo Donoso, MD, can be reached at Av. Luis Pasteur No. 5917, Vitacura, Santiago, Chile; +(56) 2-218-4485; fax: +(56) 2-218-5163. Dr. Donoso has no direct financial interest in any of the products mentioned, nor is he a consultant for any companies mentioned.

Rene Moreno, MD, can be reached at the Fundación Oftalmologica Los Andes, Las Hualtatas 5951, Vitacura, Santiago, Chile; +(56) 2-212-4003; fax: +(56) 2-220-7388. Dr. Moreno has no direct financial interest in any products mentioned, nor is he a consultant for any companies mentioned.

Chile’s Ophthalmology Society, Sociedad Chilena de Oftalmologia, Casilla 16197 Correo Providencia Santiago, Chile Tel.: +(56) 2-2096146 Fax: +(56) 2-2096146