|Year : 2020 | Volume
| Issue : 1 | Page : 3-4
NV Arulmozhi Varman
Department of Ophthalmology, Uma Eye Clinic, Chennai, Tamil Nadu, India
|Date of Submission||26-Jan-2020|
|Date of Acceptance||29-Jan-2020|
|Date of Web Publication||04-Mar-2020|
Dr. N V Arulmozhi Varman
Director, Department of Ophthalmology, Uma Eye Clinic, Anna Nagar, Chennai - 600 040, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Arulmozhi Varman N V. Quo Vadis?. TNOA J Ophthalmic Sci Res 2020;58:3-4
Where are we headed? This is a question that faces all of us. A bewildering array of changes at perplexing rate confronts us continuously, often raising the questions: What? When? Why? Let us for this instance, limit this question to cataract and its treatment.
Rightfully, the discovery of intraocular lens (IOL) was an earthshaking change to the treatment of cataract. We all do accept that the most common complication of cataract surgery was aphakia with its attendant visual problems. Yes, the implantation of IOL did make a significant difference to qualitative outcomes. This was immediately followed by an ultrasound scan to measure the length of the globe and along with that came formulae to calculate the power of IOL to be used to significantly reduce the ametropia. This trail had got long and winding that now, we have a plethora of instruments and different technologies to achieve an accuracy of within 0.25 D!! Is this level of accuracy necessary? Is it “market driven?” Is it due to expectation of the consumer? Difficult questions to answer in just simple terms. It is probably a combination of all the above factors and some more. The general expectation of consumers has gone up, mainly due to availability of products and technologies. Gone are the days when one had to order a car with air-conditioning; now, one has to specially order one without it. There can be no limit to improvements in technologies; this coupled with a high level of information dissemination leads to demands and expectations often outstripping the best available.
The next major step up in cataract surgery post-IOL was the innovation of phacoemulsification. This brought in faster recovery, stable vision, and lesser postoperative visits. However, even though it is less expensive, manual small incision surgery has not been able to make phacoemulsification go down the totem pole. How is it that a surgery that takes the same time and has excellent outcomes not able to overtake a procedure that is far more expensive? The answer lies in the smallest of details; patients demand no injection, no residual astigmatism, and a procedure that can accommodate the more advanced IOLs.
Story of IOLs itself is a volume. What started of as just a product to reduce ametropia, it has become a tool to completely do away with ametropia and not just that a tool to do away with higher-order aberration and more. I take the example of one of my patients who demanded total emmetropia over all distances, high quality of vision in all light conditions. Why? He was an avid shooter taking part in competitions. He was implanted with one of the newer extended depth of focus IOLs, which work on aberration principles after undergoing preliminary examination under a swept-source optical coherence tomography device, with the calculations being done on the latest online formulae; finally, the procedure was done with laser assistance. Well, the final outcome was thankfully acceptable, and this gentleman has gone on to win more competitions postoperative. This is the level of demand which is going to become more and more common.
Is this demand unreasonable? Is it a completely market- and advertisement-driven phenomenon? Not really, one has to just look at the lifestyle of patients undergoing cataract surgery in the last decade and compare to that of three decades ago. Seventy-year and eighty-year-olds are probably more active today than 40- and 50-year-olds of those decades. With more activity comes greater demands of vision and hence the need for ever-improving techniques and technologies.
Are we ever going to say enough is enough and stop by to smell the flowers? The answer is an emphatic NO.
Yet, the question still haunts us. Is the move toward laser-assisted cataract surgery really something that gives results commensurate with costs? A very difficult question to answer, but this is just one step among many that have led us to this present scenario. Any technology that does not deliver satisfaction to patients will eventually wither away, anything that flourishes will have to be respected and incorporated. Only time will give us the result. We will continue to be presented with an array of technologies continuously. One has to look at all that is offered with an open and even mind and eventually embrace appropriate technologies.
Some of us will do it earlier and some later. As Heraclitus said, “The only thing constant is change.” Are we going to be able to predict changes? Not likely as our imagination is limited while the truth is not.