Comprehensive ophthalmologists are important to eye care

General ophthalmology provides the primary services and support most patients need.

Issue: October 15, 2004

ByJeffrey R. Brant, MD

Jeffrey R. Brant, MD [photo]
Jeffrey R. Brant, MD

Comprehensive ophthalmology is alive and well in the United States. As a former editor of the Information Management Section of Ocular Surgery News and with 19 years of experience in practicing general ophthalmology, I was asked to offer my opinion about the future of comprehensive ophthalmology.

Some comments by other section editors at the OSN Section Editor Summit in Las Vegas implied that practicing general ophthalmology is not economically feasible and that general ophthalmologists lack the training to become proficient at various surgical techniques. However, I disagree with these statements.

General ophthalmologists far outnumber subspecialists in the United States. We are the portal of entry to eye care for many people. We are also the caretakers who tend to all the mundane, although important, aspects of eye care. We perform complete eye exams, prescribe glasses and contact lenses, and diagnose and treat common eye problems. Most of us have become proficient small-incision cataract surgeons. Although training in some of today’s residency programs may not provide adequate phaco experience for someone going out into the real world, new general ophthalmologists can take courses and work with experienced surgeons to improve their skills.

In our practice, the majority of our patients are elderly (over 65 years). These people tend to have serious and often multiple eye problems. They fear vision loss more than anything and turn to their general ophthalmologist for understanding and careful explanations of their eye problems. Sometimes, in such cases as advanced age-related macular degeneration, just spending a few extra minutes with the patient can provide the sympathy and support that is needed. The patient needs to be allowed to voice his concerns and needs to be told that he is not alone. Helping these patients by referring them to low-vision services and providing other resources goes a long way in improving their ability to function at home.

Patient and personal satisfaction

Quality of life is an important issue not just for our patients, but for doctors as well. As I completed my residency in 1985, I decided that I wanted to open my own comprehensive ophthalmology practice so that I could run things the way I envisioned they should run. I wanted to be able to set my own work hours and decide what eye problems I would handle myself and what problems I would refer out to subspecialists. I think the decision to subspecialize depends a lot on the ophthalmologist’s personality and desires and should not necessarily be determined by economic factors. A balance between work, family and recreation must be reached.

I enjoy providing primary eye care. I derive personal satisfaction from relieving discomfort of the patients who come to our office with common eye conditions. While this is perhaps not quite as glamorous as providing some highly skilled surgical procedure for a rare condition, these patients need proper care just the same. I have always believed that you can grow a successful practice by treating each patient as if he is your only patient. Spend some time with them and make sure all patients receive the best care you can provide.

These days, spending extra time with patients can run contrary to office efficiency. However, the rewards pay off when they refer many of their relatives and friends to your practice because of it. This is how we built our practice, without any significant marketing. Our practice quickly grew into a high-volume eye clinic with an excellent reputation, prompting patients from surrounding counties to leave their eye care providers and travel significant distances to see us because of the quality of care they knew they would receive. Another advantage of achieving patient satisfaction through personalized attention is that it goes a long way in preventing medical liability claims. Patients who feel their physician cares about them and spends a few extra minutes listening to them are far less likely to sue.

Continuing need for general ophthalmologists

As baby boomers age, the proportion of the population that is elderly will continue to increase. Cataract surgery volume will continue to grow. Comprehensive ophthalmologists should be the doctors who perform most of the cataract surgeries. However, they need to make sure they develop the skills needed to obtain excellent outcomes in nearly all cases. They also need to be able to perform the surgery in an efficient manner. Phaco surgery has a steep learning curve, and patients expect near-perfect results. Our practice is called upon to perform hundreds of small-incision cataract procedures each year. My average phaco case takes less than 10 minutes to complete, and my complication rate is extremely low. I strive to keep up with the latest techniques through CME courses and by reading publications such as Ocular Surgery News.

Refractive surgery is another area that is not for all ophthalmologists. Although I performed RK surgery back in the early 1990s before the days of LASIK, I never enjoyed it as much as cataract surgery. While a successful refractive surgery outcome provides an immensely enhanced lifestyle (I had RK performed on myself in 1991 with continued excellent results), the procedure is strictly elective. The patients tend to be highly demanding, and it is important to make sure they fully understand the pros and cons of it before they make the decision to operate. This takes a great deal of time. These patients often hear what they want to about the surgery, and then they complain when they see 20/20 uncorrected because their neighbor can see 20/10. Cataract patients, on the other hand, have no real alternative — they either have surgery or continue with poor vision. Refractive surgical candidates, in contrast, can always wear glasses or contacts.

As we move along in the 21st century, the need for comprehensive ophthalmology will continue to grow. And general ophthalmologists will also continue to be the majority of those reading Ocular Surgery News because we find the publication to be an excellent source of information for all aspects of eye care, not just “ocular surgery.”

Holladay on optics

The November 1 issue will feature Jack T. Holladay, MD, who will discuss wavefront technology and accommodating IOLS.

For Your Information:

Jeffrey R. Brant, MD, can be reached at the Allatoona Eye Institute, 962 JF Harris Parkway, Suite 201, Cartersville, GA 30120; 770-382-3598; fax: 770-382-4892; e-mail: allatoonaeye@mindspring.com.