‘Upgrade’ a new concept in refractive surgery

THOROFARE, N.J. — The concept of reoperations with no additional charge in the event of residual refractive error has become the professional standard in refractive surgery. As the technology of refractive surgery continues to advance, however, how does the surgeon distinguish between fixing a minor imperfection in an existing procedure and performing a completely different improvement?

Dan Durrie, MD, believes refractive surgeons need to take a hard look at the concept of “enhancements” from both a medical and financial angle. He has begun using the term “upgrade” to describe reoperations that involve newer technology and greater precision.

“This is a patient education issue. Patients need to be told up front that there may be additional costs involved as better technology emerges or as their own vision situation changes,” Dr. Durrie said. He said patients are familiar with the concept of upgrading in computers and other electronic products, so they accept the idea readily.

He said the concept of “enhancement” goes back to the radial keratectomy days of the mid-1980s when Charles Casebeer, MD, coined the term to use in place of “redo” or “reoperation.”

“We used the term to increase patient comfort about undergoing a second surgery,” Dr. Durrie said.

Dr. Durrie said he believes that recently approved treatments for hyperopia that are labeled “temporary” make lifetime guarantees difficult.

Dr. Durrie said his chief concern is not misleading patients.

“The way we refer to things now, hyperopic patients could expect lifetime free enhancements. What I call ‘enhancements’ really can occur only during the healing period,” he said. “After that, most of the time anything else is an ‘upgrade.’

“Right now we are caught up in the idea that refractive surgery is a patient that comes in, gets surgery, is followed for 3 months. We must understand that we will continue to have new technology to offer to the hyperopic or presbyopic patient. I educate patients that the nature of their refractive error requires additional treatments. They understand that and appreciate it,” Dr. Durrie said.

More on this, including comments from other surgeons, will be published in the June 1 print edition of Ocular Surgery News.