EDITOR'S PAGE

Shifting Gears

by Rich Kirkner

It's hard to believe that five years have passed since we did our first annual refractive surgery issue. Back then the hype was about PRK for low to moderate myopia. Now, LASIK has made PRK all but obsolete, and investigational procedures such as corneal implants are getting good results. Now, patients with even severe levels of myopia, hyperopia and astigmatism can one day expect to have their choice of corrective surgeries.

All this points up to a paradigm shift in eye care. Where you once were concerned with purely prosthetic correction—eyeglasses and contact lenses— you've become more involved in surgical correction. It won't be a full shift. People will always be willing to wear glasses and contact lenses. But, this paradigm shift involves dispelling a few misperceptions about refractive surgery. Among them:

• It's a vanity thing. Refractive surgery is no longer just cosmetic surgery. Those high myopes who fumble for their glasses every morning don't see surgical correction as just another nose job. This is a legitimate procedure that fixes a legitimate health problem: bad vision.

• If I ignore it, it will go away. You have colleagues who won't refer for refractive surgery because of what they fear it will do to their dispensaries or contact lens practices. (Fortunately, these doctors are in the minority; nine of 10 O.D.s do comanage refractive surgery, according to this month's National Panel, Doctors of Optometry.) If you ignore it, the only thing that will go away are your patients who want to learn more about it.

• Refractive surgery is a license to print money. No way. (See my August column, "CVS: Optometry's Sleeper Subspecialty.") The cost will come down, and so will your comangement fees. Nonetheless, laser vision correction is something your patients will demand to know about. They'll believe what you tell them. They'll need a trustworthy doctor's opinion to make sense of the all the noise they're hearing about refractive laser surgery. No get-rich-quick scheme here for you, doctor.

Optometry has positioned itself well to meet this new paradigm in eye care. The TPA movement is pure prescience. Expanded privileges will help. So, too, will resolving the issue of refractometry for opticians.

But know that for your patients with poor vision, surgery isn't just an issue of vanity. It's an issue of sanity.

This month a familiar face returns. Rob Murphy, whom many of you got to know as our Senior Clinical Editor, is taking up the reins of Managing Editor. He'd been Senior Editor for our former sister publication, Jewelers Circular Keystone, for the past year. Please join me in welcoming Rob back to optometry.