BLOG: Living well means seeing well
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Although you won’t read about it much in the news, the coronavirus pandemic brought about a number of positive influences in many people’s lives.
Isolated at home, many have rediscovered the wonders of the outdoors, getting exercise and reacquainted with nature, helping them cope with the stress of the pandemic. Many have spent more time with family. Others have improved their homes, as evidenced by the dramatic increase in mid-year Home Depot earnings and the packed schedules of building contractors. And an increasing number of patients have come to us in the past few months to invest in self-improvement with LASIK and refractive cataract surgery. Some practices have more than doubled their procedure volumes relative to 2019. Free of most of the usual life distractions and reexamining life priorities, our patients seem to have discovered a truth about which our specialty has probably failed to adequately inform the public — that living well means seeing well.
With about 11% of U.S. cataract procedures receiving a toric or presbyopia-correcting IOL, we are barely scratching the surface with adoption. Market research studies have repeatedly told us that 80% of patients would strongly consider refractive cataract surgery if they fully understood the offering. But many patients never hear about them, or the subject is glossed over because many surgeons feel an unspoken sense of guilt in educating patients about a procedure that has an additional profit margin for the practice. This is simply not in the patient’s best interests.
Evidence strongly suggests the permanent lifestyle benefit that refractive cataract surgery conveys. One of the greatest fears of the older cataract population is falling later in life. Our colleague, Daniel Chang, has made many of us aware of a 2002 study published in the Journal of the American Geriatric Society showing that bifocal, trifocal and progressive spectacle lenses — lenses that patients won’t need with a toric or presbyopia-correcting lens — are associated with a 2.3 times relative risk for falling among older adults. Of all the falls in older adults, one in three is associated with these types of spectacles because patients miss a step in their lower field of view, which is distorted by the reading add. About half of these falls lead to injury, and about 15% lead to serious disability, according to a 2011 article in the Canadian Journal on Aging. In 2014, falls in the elderly led to 27,000 deaths in the U.S., more than caused by breast or prostate cancer. In fact, according to the CDC, the total cost of fall injuries in the U.S. was $31 billion — more than the size of the entire U.S. ophthalmology industry. Further, the numerical evidence fails to capture the personal side of this story, in which doing away with glasses imparts a sense of freedom that every cataract patient deserves.
What about LASIK? Here, the evidence is even clearer in favor of the procedures we perform. In 2009, Kerry Solomon and co-authors published a landmark LASIK world literature review, evaluating quality of life and patient satisfaction, beginning with almost 3,000 retrieved citations and evaluating each publication for both its quality and scope. Nineteen articles specifically addressed quality of life and patient satisfaction with LASIK on a total of 2,198 subjects. Overwhelmingly, patients were satisfied, with 95.4% reporting satisfaction. Both myopic and hyperopic procedures had similar satisfaction scores. Compared with other self-improvement surgeries, such as brow lifts, liposuction, rhinoplasty, skin tightening and Botox injections, LASIK clearly had the highest range of satisfaction of all these procedures. Moreover, this and other studies of LASIK reflect what all of us hear from patients and friends every day — that LASIK made their lives better.
As a specialty, eye care needs to embrace the link between quality of life and doing away with spectacle lenses. We need to discipline ourselves to educate (not sell) the benefits of these options with more patients, and we need to put aside feelings of guilt in offering services that are not covered by insurance. Our patients are motivated. The technology is safe and effective, and the quality of life benefit is immediate and profound.
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