This article is more than 5 years old. Information may no longer be current.
Are we trivializing cataract surgery?
Click Here to Manage Email Alerts
At first, the questions seemed fairly typical for anyone with cataracts: Are there alternatives to surgery? What are the risks? Do I have to stay in the hospital? Then the questions became more pointed: There aren't any needles involved, are there? No stitches, right? Is it true that I won't need glasses afterward? Finally, the ultimate question: Can I golf that afternoon?
Gulp!
No doubt, few areas of eye care — or medicine, for that matter — have evolved as rapidly over the past decade as cataract surgery. First, there was the shift from inpatient to outpatient, giving patients a sense that cataract surgery was no longer a risky proposition. Then there were the technical enhancements, as surgeons moved from intracapsular to extracapsular to phacoemulsification, with 6 mm limbal-based incisions giving way to scleral tunnel and clear corneal incisions.
Of course, these innovations lessened the need for retrobulbar or peribulbar blocks, and ushered in the era of preoperative nonsteroidal anti-inflammatory drugs, topical anesthetics and intraocular Xlocaine (lidocaine HCl, Astra) drops. Couple these advancements with IOLs that are less reactive, foldable, UV-absorbing and multifocal, and you have the marvel of modern day cataract surgery, a procedure which is safe, expedient and efficacious. We know this and our patients are coming to realize it as well.
Perhaps the most vocal proponents of cataract surgery are the 1 million Americans who undergo the procedure annually. They are quick to share their experiences with friends and family. And in these competitive times — when offering the "latest technology" is paramount — it is easy to see why clinicians are equally zealous about cataract surgery. What is not wise, however, is to trivialize something as significant as cataract surgery in doing so.
So, how do we temper our patients’ enthusiasm with a dose of reality? First, be sure they understand that cataract surgery can take longer than 15 minutes, occasionally requires stitches and does not always result in uncorrected VA of 20/20 & J1 at the 1-day postoperative visit. Secondly, inform them that complications can — and do — occur as a result of cataract surgery. Just ask anyone who has experienced an expulsive choroidal hemorrhage, endophthalmitis, cystoid macular edema or retinal detachment.
In the final analysis, if we don’t treat cataract surgery and its perioperative care as the highly technical and skilled discipline it is, who will? Our patients? Maybe. Insurers? Judging by the trends in reimbursement, I don’t think so.