Innovations for refractive surgery

It is an honor to write the editorial for the ASCRS edition of EyeWorld. In this position I hope to give each of you a glimpse of the issue you may very well be reading as you are in Boston. Going to one of the major meetings is always a contemplative time for me personally and I presume it is for virtually any ophthalmologist. Most importantly we have the opportunity to reacquaint with many of our long time friends, fellow residents, mentors and colleagues. I believe two very important things occur while at a meeting the size of ASCRS. Importantly, the meeting becomes a litmus test of what you are or are not doing. Are you missing out on some new advance? Is it time to jump on the wagon of a trend you have been watching? Or, were your suspicions right, and should you continue to monitor the progress or lack thereof of the device or procedure you have been following? Secondly the meeting of the scale of ASCRS annual meeting allows for you to obtain a visceral gut check of where your practice is today and where you might be best navigating it over the next 1-5 years. Your pin-points for this navigation can oddly occur in many a place. It may be in a course or symposium when the light-bulb goes off or it may be at a company booth on the exhibit floor or it could be in an unexpected place like a short elevator conversation or conversation over a few drinks at a watering hole. In any of these instances it is then all about what you do with this cumulative information in quiet meditation about your particular course and guidance you contemplate for your practice. In this issue of EyeWorld and at this year’s ASCRS meeting I believe there will be more than ample information for you to direct and perfect your practices’ course. Personally, I do not believe any of us can stay on the same course as we were on say in 2007 and expect desirable outcomes for our practices as we know it. The reason I say this is that our federal government simply does not have the monies in hand to provide for all the social wants and promises that have been made. As such we can expect decreases on-going for our individual work units as they are reimbursed by CMS and all the insurance companies that bench-mark off of the CMS fee schedules.
So what can you do? I think it is imperative for each of us to try to work as free as we can from third party payers and let the free market determine the value of our services, experience and expertise. Frankly, this is the only light I see at the end of the tunnel for you to self-determine your practice. In this issue of EyeWorld there is ample opportunity to help you navigate your journey. If there is one “must read” article in this issue it is the article by David Laber Don’t expect a large bounce in refractive procedures in 2010. While the content might not surprise us it is completely sobering to see it in black and white. Many of us have already changed course but it is helpful for us to plan for when the refractive tide rises again. Another article worth considering is by Enette Ngoei entitled Considering refractive lens exchange. While some have hesitation about refractive lens replacement/exchange or clear lens extraction or near-clear lens extraction. I believe it does have its place. For a patient to have Lasik and then have to have lens extraction and IOL placement 2-3 years down the road due to lenticular opacity is certainly disappointing to the patient. It is my hope that as you read this edition of EyeWorld and hopefully experience a Boston ASCRS meeting that you gain valuable insight to direct your practice to the desired destination.

John Doane, M.D.
ASCRS Refractive Clinical Committee