Future direction of ophthalmology

[davidc4498]

Hi everyone,

I'm a MS3 strongly considering pursuing a residency in ophthalmology. I'm curious as to the direction ophthalmology is going with regard to the balance between medicine and surgery. Is it going to become a more medical field or a more surgical field? From my limited exposure, it seems like medical management seems to be prevailing (ie. intravitreal injections, etc.). But at the same time, surgical management is so good these days with limited complications, I wonder if it would get so advanced to the point that surgery will become a more first line treatment for various diseases like glaucoma, amd (ie. epimacular brachytherapy), etc. I really love surgery, so this is an important question that i need to answer. Any thoughts from this forum would be so appreciated as I try to make this important decision. Thanks!!!

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[200UL]

Your post points out that ophthalmology is an evolving field. Yes, new treatments are developed. Pharmaceuticals will continue to play a larger role for some diseases (AMD/Diabetes), but many conditions will continue to need surgery (and sticking a needle in an eye is surgery in my opinion).

Depending on where you practice/style of practice, ophthalmology can provide more procedures than any field in medicine and I actually feel there will be a shortage of ophthalmologists to provide these procedures in the future for the most part (this might not apply if you want to live in Manhattan or downtown Chicago).

Reimbursement will likely continue to fall because we have become very efficient in our procedures, but ophthalmology is one field where are procedures/treatments actually make a difference. (No-one will ever be able to criticize the “cost effectiveness” of cataract surgery – One can easily criticize to “cost effectiveness” of 30 years of Lipitor use at $100/month). Therefore, if CMS/insurance companies actually look at impact of a treatment on a patient’s quality of life when determining what a procedures is “worth”, ophthalmology would do very well.

In other words, it is hard to imagine a day when one can take a pill to treat ptosis, put on a detached retina, or emulsify a cataract. How much surgery you do will depend on where you practice and your practice style.

PS I don’t believe brachytherapy will be used on a large scale in the future of AMD treatment. To me, putting relatively high dose radiation near an atrophic retina seems like a crude pretty treatment. Then again, frying peripheral retina with laser in the case of diabetic retinopathy is pretty crude as well.

 

[Visionary]

Your post points out that ophthalmology is an evolving field. Yes, new treatments are developed. Pharmaceuticals will continue to play a larger role for some diseases (AMD/Diabetes), but many conditions will continue to need surgery (and sticking a needle in an eye is surgery in my opinion).

Depending on where you practice/style of practice, ophthalmology can provide more procedures than any field in medicine and I actually feel there will be a shortage of ophthalmologists to provide these procedures in the future for the most part (this might not apply if you want to live in Manhattan or downtown Chicago).

Reimbursement will likely continue to fall because we have become very efficient in our procedures, but ophthalmology is one field where are procedures/treatments actually make a difference. (No-one will ever be able to criticize the “cost effectiveness” of cataract surgery – One can easily criticize to “cost effectiveness” of 30 years of Lipitor use at $100/month). Therefore, if CMS/insurance companies actually look at impact of a treatment on a patient’s quality of life when determining what a procedures is “worth”, ophthalmology would do very well.

In other words, it is hard to imagine a day when one can take a pill to treat ptosis, put on a detached retina, or emulsify a cataract. How much surgery you do will depend on where you practice and your practice style.

PS I don’t believe brachytherapy will be used on a large scale in the future of AMD treatment. To me, putting relatively high dose radiation near an atrophic retina seems like a crude pretty treatment. Then again, frying peripheral retina with laser in the case of diabetic retinopathy is pretty crude as well.

Agreed. Ophthalmology will always be a surgical field first. There are clearly more medical approaches in development to treat certain diseases, but surgical approaches will always be needed. I really don't see things becoming more surgical, though, except possibly for an increase in the use of implants for long-term drug delivery. And I, too, doubt the future of brachytherapy. The soon to be multi-pronged pharmacotherapy approach will trump radiating the retina/RPE/choroid. Long-term anti-VEGF treatment (e.g., Macugen microspheres) may also eventually supplant laser for PDR, at least in compliant patients.

 

[MstaKing10]

True that there are medical advances, but keep in mind that there are surgical advances at the same time. Who would've even considered pealing the ILM to relieve chronic CME 20, 15, heck, 10 years ago?? The morbidity to vitrectomy surgery was huge. Now we have smaller guage surgery with more efficient cutters and instrumentation making surgery safe and effective. Thus, the indications for surgery also change and advance over time. The same can be said for cataracts etc. 20+ years ago extracaps where the norm, thus doing surgery on a 20/30 cataract was unthinkable. Now with small incision suturless surgery some consider performing clear lens exchanges and other refractive procedures on 20/20 eyes.

Ophthalmology will remain a surgical subspecialty that benefits from advances in technology in both the surgical and medical arenas