As for the 'commercially successful' ophthalmologists, the ones doing 1000s of cases every year. I found this letter to the editor of AAO's EyeNet magazine a pretty good reflection of something I have observed in several cities so far (I hope the AAO and the mods here don't crucify me for the copyright infringement):
http://www.aao.org/news/eyenet
Phacomania: A New Phenomenon?
They always tell you how many cases they did in a day. It is a compulsion. You are supposed to be impressed. Six, seven or eight cases per hour. Each case perfect with no vitreous loss, 20/20+ vision, one day postop and a crystal clear cornea. They usually tie up two or three operating rooms and come in with a small army of support personnel to keep the flow going. They are truly gifted surgeons.
But what about the indications for cataract surgery? Does anyone ask the patient about their visual needs or how much trouble they are having? Ill bet not. The indications for surgery must be loose. The technician gets the glare meter out and tells patients how poor their vision is and how bad the numbers are.
But I seem to see pretty well and am not really having a problem, other than occasional difficulty seeing the golf ball. The retiree is unable to see a golf ball at 100 yards and would benefit from cataract surgery. Why deny this geezer the only pleasure in life that he has left? I must be seeing a whole lot worse than I thoughtguess I better get these cataracts out.
So this is what cataract surgery has come to. The surgeon will do the most cases possible and let the system absorb the cost. Occasionally, the patient shows up to the operating room and hadnt seen the surgeon preoperatively. They are slowly killing the goose that lays the golden egg, ruining the system for those who do not practice that way.
The cataract surgery decision is99.8 percent of the timemade by the patient. They decide how much trouble they are having in their life, not the technician or ophthalmologist.
A conscientious ophthalmologist will actively listen to the patient and help with the decision. You do not need 20/20 vision in each eye to get through the gates.
Phacomania is a form of slow insanity practiced by an ever-increasing number of ophthalmologists who dont want to deny the world their surgical talents.
Judson P. Smith, MD
Fort Worth, Texas