Cataracts and.....?

[opthointerested]

Advertisement - Members don't see this ad

So, I realize that cataracts are the bread/butter of ophtho but as a general ophthalmologist what are the other common surgeries and how often do you do them?

 

[7ontheline]

http://forums.studentdoctor.net/showthread.php?t=700341

Since it apparently is too much effort to scroll about 1/3 of the way down the main page. . .

 

[MR1]

yes this has been asked many times and searching not far will give me info on it. One main thing to consider is that it does vary a lot from one general ophtho to another. Also depends on if you are in a big city with a large amount of subspecialists.

Most surgeries will be cataracts, with multifocal and toric IOLs now some are focusing on those as well. For those that want to most residencies should train you well in simple horizontal strabismus (like said previously examining and taking care of kids is a whole different ballgame and often even simple stuff gets referred). Easily do retinal and glaucoma lasers. Maybe trabs. General guys doing penetrating keratoplasty is becoming less and less as cornea surgery has evolved to include other slick stuff like DSAEK. Should be comfortable with blephs and horizontal lid tightenings.

Most glaucoma tubes (and other new things they are doing), complicated plastics or orbital, retina, corneal, and complicated strabismus gets referred.

Oh of course open globes as no one really wants to do those.

 

[opthointerested]

Thanks for the help MR1

 

[eyehope]

The answer depends on your location, your training, your experience and your medical practice. In general, the more remote you are living, the more you can do (or perhaps, justify doing). In larger cities, everyone becomes subspecialized.

That said, I think most residency programs (now) give you training for:

1. cataract extraction +/- Toric, accommodative, multifocal lenses
2. YAG capsulotomy (for posterior capsular opacities after cataract surgery)
3. focal/PRP/grid laser for diabetes, vein occlusions
4. juxtascleral/intravitreal injections for macular edema, macular degeneration- but, almost all generalists will refer out (if there is a local retina doc) because of liability
5. ALT/SLT/CPC diode for glaucoma
6. trabeculectomy/mini-express/setons - I think this is highly variable by residency program.
7. LASIK/PRK refractive surgery
8. ptergyium surgeries
9. eyelid surgeries - blepharoplasties, lid tightening procedures
10. in office eyelid biopsies, chalazions
11. some horizontal muscles for strabismus - residency dependent
12. ruptured globe repair (without foreign body)

I think (my opinion only) most generalists will probably refer out:
1. most strabismus cases - unless you really love kids
2. most trabs/setons - steep learning curve, IMO
3. corneal transplants, especially with DSAEK
4. ocular cancers
5. orbital masses/cases/decompressions
6. orbital fracture repair
7. retinal surgeries - vitrectomies, sutured lenses
8. neuro - enough said.

 

[MR1]

My only disagreement is with LASIK and PRK. I don't think the majority or really even a minority of residencies teach this well. Yes you might get to watch or even certified on the laser but I doubt you would get enough as primary surgeon to be comfortable like with cataracts. Also I think the way of a general ophtho doing these is going away anyway with all the cornea folks out there and the decreased demand for it.

 

[eyesupply]

I think (my opinion only) most generalists will probably refer out:
1. .

Sub-specialists often do things a bit better even though generalists think they are just as good. This is true in most medical specialties. However, even the general ophthalmologists are not generalists. They often do cataract surgery very well.

 

[EyeMD116]

So, I realize that cataracts are the bread/butter of ophtho but as a general ophthalmologist what are the other common surgeries and how often do you do them?

www.eyetube.net

Spend some time on here and you'll have a pretty good idea.

 

[opthointerested]

Awesome, thanks everyone for the responses. I'll be sure to check out as many of those videos as possible eyemd. I have already seen a couple and it's pretty sweet.

 

[odwire usa]

The answer depends on your location, your training, your experience and your medical practice. In general, the more remote you are living, the more you can do (or perhaps, justify doing). In larger cities, everyone becomes subspecialized.

That said, I think most residency programs (now) give you training for:

Your answer is so good for beginners.

I can do nearly half of the surgeries you listed.

PS. The answer also depends on different countries. Right?

 

[MstaKing10]

The answer depends on your location, your training, your experience and your medical practice. In general, the more remote you are living, the more you can do (or perhaps, justify doing). In larger cities, everyone becomes subspecialized.

That said, I think most residency programs (now) give you training for:

1. cataract extraction +/- Toric, accommodative, multifocal lenses
2. YAG capsulotomy (for posterior capsular opacities after cataract surgery)
3. focal/PRP/grid laser for diabetes, vein occlusions
4. juxtascleral/intravitreal injections for macular edema, macular degeneration- but, almost all generalists will refer out (if there is a local retina doc) because of liability
5. ALT/SLT/CPC diode for glaucoma
6. trabeculectomy/mini-express/setons - I think this is highly variable by residency program.
7. LASIK/PRK refractive surgery
8. ptergyium surgeries
9. eyelid surgeries - blepharoplasties, lid tightening procedures
10. in office eyelid biopsies, chalazions
11. some horizontal muscles for strabismus - residency dependent
12. ruptured globe repair (without foreign body)

I think (my opinion only) most generalists will probably refer out:
1. most strabismus cases - unless you really love kids
2. most trabs/setons - steep learning curve, IMO
3. corneal transplants, especially with DSAEK
4. ocular cancers
5. orbital masses/cases/decompressions
6. orbital fracture repair
7. retinal surgeries - vitrectomies, sutured lenses
8. neuro - enough said.

I think this is a pretty good list. I think all general ophthalmologist should feel comfortable doing those procedures listed INCLUDING PRK and LASIK. For those that have done the surgery, you will agree that its not the surgery that is difficult (line up the eye, and press the pedal), it's the patient selection and education/consent/chair time where the real challenge lies. Most of this can be learned in residency and if you join a group with a thriving LASIK/PRK component, you will be guided along to get you up to speed in terms of patient selection and the like.

As has been mentioned before, a lot of this is based on the general practice patterns in the area where you are practicing. For example, where I am now, most comprehensive guys do laser PRP and focal without any problems. In other areas, this would not fly.

I think with all the changes in health care and reimbursement issues, comprehensive ophthalmologist should not follow the "need to be a specialist to do X procedure" mantra, rather, learn all that you can and perform as many types of procedures as you feel comfortable doing.

Also keep in mind that you can learn many procedures AFTER you graduate residency as well. Most of my faculty didn't learn phaco until well after they graduated. So will we have to learn different procedures to keep up with technology and ever changing practice patterns. It's what makes our specialty so interesting!!

 

[odwire usa]

Also keep in mind that you can learn many procedures AFTER you graduate residency as well. Most of my faculty didn't learn phaco until well after they graduated. So will we have to learn different procedures to keep up with technology and ever changing practice patterns. It's what makes our specialty so interesting!!

I absolutely agree to your opinion.

 

[keegan]

I know you've been offered alot of info already, but maybe this will help too. At our practice, with each doctor seeing between 50-70 patients a day depending on the day of the week, have about 48 cataracts, 10-12 Yags, 4-5 SLT's, 6-8 chalazions, and will do punctal plugs in office maybe 10 times per month I'm guessing. Occasionally there are certain muscle surgeries, ptosis, and pterygium surgeries, but those are very infrequent.

Hope that helps

 

[KHE]

I know you've been offered alot of info already, but maybe this will help too. At our practice, with each doctor seeing between 50-70 patients a day depending on the day of the week, have about 48 cataracts, 10-12 Yags, 4-5 SLT's, 6-8 chalazions, and will do punctal plugs in office maybe 10 times per month I'm guessing. Occasionally there are certain muscle surgeries, ptosis, and pterygium surgeries, but those are very infrequent.

Hope that helps

For perspective, can you clarify how many doctors are in the practice?

Also, the surgical volume you've listed is per month or per week?

 

[DrMassacre]

I know you've been offered alot of info already, but maybe this will help too. At our practice, with each doctor seeing between 50-70 patients a day depending on the day of the week, have about 48 cataracts, 10-12 Yags, 4-5 SLT's, 6-8 chalazions, and will do punctal plugs in office maybe 10 times per month I'm guessing. Occasionally there are certain muscle surgeries, ptosis, and pterygium surgeries, but those are very infrequent.

Hope that helps

Are those numbers per doctor per month?

 

[Stark]

As mentioned, procedures vary on subspecialty coverage in your location. However, I was amazed to see in Manhattan, of all places, that certain general ophthalmologists do procedures that seem like they could or should be done by subspecialists (with a subspecialist on every corner of the city).

For example, one general ophthalmologist routinely did DCRs (dacryocystorhinostotmies) rather than oculoplastics, another routinely did a ton of muscle surgery rather than pediatric ophthalmology, and a third did all the PRP and focal lasers on her patients rather than a retina specialist.

So basically, even in markets with tons of subspecialty coverage, you can carve out a niche in almost anything you're trained to do (if you really want to).

On the other hand, our local Medical Association passed a bylaw that corneal transplants could only be done by a cornea fellowship trained surgeon. Reasonable to be sure, but it was passed at a time when phaco was new, and if you were the surgeon who killed the cornea, you were the surgeon who fixed it. Now the market is saturated with cornea specialists and generalists aren't killing as many corneas. . .