Ophtho_MudPhud and anyone else who wants to read this...
I didn?t want this to get into a discussion about PRK because I?m not a big fan of it. Destroying Bowman?s Membrane is not good for healing. The procedure itself is also not particularly good on patients since they sometimes have to endure six months of steroids and blurry vision. LASIK is the way to go nowadays, although I?m not convinced this is particularly a great procedure either. It?s good for some people though, but I?m not going to elaborate further.
I still maintain that PRK is not complicated. 1) The computer does most of the work. Even an OMD can get this wrong. 2) 90% of PRK screening involves history. Who can?t take a history? It?s a few questions. Have a pre-printed form with all the possible risks and you have most of what you need. Now it comes down to looking at the patient. We know what is normal and what is abnormal. That?s what we were trained for. OMDs spend a lot of time on diagnosis and treatment. We spend a lot of time on diagnosis. That?s all it takes to screen PRK patients. And anyone who invests in a million dollar instrument is going to damn well know what is normal and what isn?t. What we are talking about is doing PRK on normal, healthy people. If there is anything that appears suspicious, refer to a corneal OMD specialist. Get his or her opinion and if the risk is minimal, proceed with PRK. If not, get glasses. 3) Lasers can blind? Sure, but we are talking about the excimer laser. Show me a list of patients who have had their corneas penetrated by the excimer and that will prove that people go blind from PRK. Excimer lasers do not blind. If anything, it?s the steroid use that blinds. Steroids can cause cataracts, and OMDs are still using Pred Forte and other steroids that are well known for causing them. NSAIDs can cause corneal melts and that can blind too. Use either of these drugs too much and there is the potential for damage. ODs are fully trained to recognize when things are going awry and can make adjustments. As I say, PRK patients may have to endure six months of therapy. That?s the time to be most careful?not the surgery. 4) Corneal specialists are there to help us when things go awry during PRK. Since 99.9% of the time there will be no emergency that requires an M.D. to be on staff during PRK, a referral can be made if there are any complications.
Ophtho_MudPhud said, ?I don't buy the arguement that because no scalpel is involved then it's not complicated and therefore safe. Lasers are surgical instruments.? I could not agree more. However, I did not make the argument that because there is no scalpel it makes it safe. I don?t buy it either. I am saying that it does make it LESS complicated. There is less chance of operator error by making the laser do all the ?cutting.? (Excimer lasers don?t cut, they ablate?but you know what I mean).
What I don?t buy is this argument about what is best for the patient! Do we always do what is BEST for the patient or do we sometimes do what is best for us or what is best for the patient economically? I can give you countless examples of doctors of all professions who compromise patient safety in the name of personal gain or dollar saving. How about doing LASIK instead of giving the patient glasses? Now we get into the argument of the ethics of LASIK.because there is the potential for loss of vision for an elective procedure. What about writing an Rx for a drug that is under the patient?s insurance company formulary when the doctor knows there are more effective, newer medications on the market? Don?t give me this argument about doing what is best for the patient. It?s a nice thing to say but it?s not always true. OMDs want all the business of surgery, plain and simple. It?s an economic issue.
If it was about patient safety, then OMDs should not let their staff do refractions. They are incompetent! OMDs should refer all of their patients to us ODs for refractions and glasses. After all, if the refraction isn?t right, then isn?t that endangering the lives of other drivers? Isn?t that endangering the lives of our kids when they ride busses with bus drivers that got their exams from incompetent staff members? Where did they get their education? From a book? From a two hour class? If that!
This is not just an issue about PRK. It?s an issue about doing minor surgeries such as iridotomies, chalazion and papilloma removal. Can you tell me how dangerous these procedures are? Clearly the last two are not dangerous at all! You have to admit that.
I stand by what I said.
I?m not saying we ODs want to be OMDs. Far from it! In my case, I don?t want all the surgeries. I don?t want all the end-stage glaucoma cases, I don?t want the trauma, I don?t want the scarred corneas, I don?t want to do cataract surgery, and I don?t even want LASIK or PRK. If I wanted these things I would have gone to medical school (I?m sure you?ve heard this argument before too). I don?t want to be an OMD, thanks. Believe it or not, I think I can make more money as an OD than an OMD. That?s another topic for another day?
As such, we have what we have, and we want minor surgery.
Just thought I'd put this face in since it's kinda funny.
