Ophthalmology Business

OCT 2013

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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Managing patient by Michelle Dalton Contributing Writer Reeling in unrealistic expectations may mean convincing patients to wait a bit longer or declining surgery altogether T he scenario is all too common—a potential laser vision correction patient comes to the office, excited to be spectacle-free (or at least to rely a lot less on glasses and/or contact lenses), and undergoes the gamut of preop testing. Topography is normal. The patient may have low corneal cylinder and a normal-to-high corneal thickness, but tomography shows a flag. Or a patient presents in his/her 6 late 30s as a high myope, develops a retinal tear that creates a cataract and decreased best corrected visual acuity in one eye. Or a patient does not understand that any kind of laser vision correction is not going to prevent presbyopia. "I tell patients everyone gets a stiff lens and loses the ability to read, no matter if they have laser vision correction or not," said Vance Thompson, MD, director of refractive surgery, Vance Thompson Vision, Sioux Falls, S.D. "I've even told patients there used to be only two sure things in life—death and taxes. There are plenty of people in the news who don't pay their taxes, so now I tell them the only two sure things in life are death and presbyopia." Ophthalmology Business • October 2013 The "golden rule" of medicine is to give patients the same treatment you would want to receive, said Uday Devgan, MD, in private practice in Los Angeles, and chief of ophthalmology, Olive View – UCLA Medical Center. Dr. Devgan said if any preop diagnostic test came back questionable, "I would want my doctor to tell me I may not be the best candidate in the world for the procedure and here's why." If his patients are willing to accept some of those higher risks, Dr. Devgan will usually proceed with the surgery. "If the patient is at a much higher risk for potential complications and our preop diagnostic tests determined that, I would rather err on the side of caution and opt against any kind of surgery," Dr. Devgan said. Borderline cases are often the hardest for Carlos Buznego, MD, in practice at the Center for Excellence in Eye Care, Miami, and voluntary assistant professor of ophthalmology, University of Miami's Bascom Palmer Eye Institute—especially those that are highly motivated for laser vision correction. "Telling a patient you're not sure you have the magic bullet they want can be difficult," he said. "But don't give into patients just because they're insistent. As surgeons we have to be strong and not allow the patient to talk us into something we don't think is right." He includes early enhancements among those gray areas. Technology is not the be-all and end-all, said Y. Ralph Chu, MD, in private practice, Chu Vision Institute, Bloomington, Minn. "It's not an absolute answer. There is still some aspect that has to be applied to the science and that's a personal

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