What if cataracts did not exist?

[slitlamp1234]

For the sake of argument let's say someone invented a single pill that eliminated all cataracts (both current and future)... What would happen to the field of ophthalmology? Would it be possible to sustain a comprehensive practice or would this force everyone into a sub specialty? Clearly this will likely never happen but I was just trying to think of something interesting to debate while I await match day.

Would a ton of residency programs shut down?

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[Meibomian SxN]

For the sake of argument let's say someone invented a single pill that eliminated all cataracts (both current and future)... What would happen to the field of ophthalmology? Would it be possible to sustain a comprehensive practice or would this force everyone into a sub specialty? Clearly this will likely never happen but I was just trying to think of something interesting to debate while I await match day.

Would a ton of residency programs shut down?

With such lack of knowledge of your future match, I would hope no one chooses you for an ophthalmology match...

 

[JMK2005]

For the sake of argument let's say someone invented a single pill that eliminated all cataracts (both current and future)... What would happen to the field of ophthalmology? Would it be possible to sustain a comprehensive practice or would this force everyone into a sub specialty? Clearly this will likely never happen but I was just trying to think of something interesting to debate while I await match day.

Would a ton of residency programs shut down?

There's no point your hypothetical. You already know the demand for ophthalmologists would suffer.

 

[MstaKing10]

Clearly this will likely never happen but I was just trying to think of something interesting to debate while I await match day.

Think harder.

I hope for your sake you didn't mention this doozy during the interview, otherwise, I think you'll be waiting a LONG time for the match.

 

[cme2c]

Not sure why you all are being so harsh. It's a valid thing to consider. Cataract surgery is a big money maker for ophthalmology, so it's reasonable to consider what may happen if that were to go away.

 

[MR1]

I have no idea about the research being done in this area but I can imagine if there were such a pill\drug discovered it wouldn't prevent all cataracts such as those after PPV, trauma, steroid use, etc

So there would probably still be a need for cataract surgeries, just much less a need

Obviously demand for general ophtho's would go down, but cataracts is not all general folks do. Most current general folks would have to branch out if they weren't already and do more glaucoma procedures, minor corneal stuff, minor plastics things, medical retina, maybe even strabismus.

Most current and future residents would be pushed to do fellowships as well. Probably would see a slow downsizing of residency spots, definitely no new spots.

My guess is the reality would be something that slows cataracts or decreases the incidence but doesn't do away with them totally. Even without that magic pill, one of the reasons I am pursuing a fellowship is to get away from comprehensive ophthalmology as I see it being so much less desirable than it used to be.

 

[Visionary]

I actually remember there being buzz a few years back about a topical agent, a combination of EDTA and methylsulfonylmethane (MSM), that may be able to slow or reverse cataracts, but I haven't heard anything about it recently. I agree with MR1 that any such drug would likely only be effective for certain types of cataracts, probably nuclear sclerotic. There would be plenty of other cataracts out there. Additionally, comprehensive ophthalmologists already perform many other procedures, including refractive (including elective clear lens exchange with multifocal IOL implantation), glaucoma, lid, etc. I think the overall effect would be marginal.

 

[Meibomian SxN]

I actually remember there being buzz a few years back about a topical agent, a combination of EDTA and methylsulfonylmethane (MSM), that may be able to slow or reverse cataracts, but I haven't heard anything about it recently.....

Similasan Cataract eye drops; they work "wonders"...
http://www.similasanusa.com/eye-drops-and-eye-care

 

[Visionary]

Similasan Cataract eye drops; they work "wonders"...
http://www.similasanusa.com/eye-drops-and-eye-care

Funny, but this is what I was talking about:

http://www.osnsupersite.com/view.aspx?rid=21815

I imagine nothing has come of it, as this is over 3 years old. Either that or some ophthalmology mafioso made it go away.

 

[eyesupply]

What happens if cataract surgery reimbursement drops from $2500 to $500? I heard some Medicaid plans are paying in the 400's making surgery and several post op visits paying less than one new glaucoma patient.

Answer: Ophthalmologists would just bend over and say "please don't spank me too hard".

General surgeons survived when laparoscopic cholecystectomies became standard in the early 1990's.

Even if there were a single one dose pill to cure diabetic retinopathy, glaucoma, and catarcts, there would still be a need for ophthalmologists. Such pill doesn't exist for pneumonia or vaginitis so why eye conditions?

Even the TV repair man and Maytag repair man did not disappear overnight.

 

[DiveMD]

For the sake of argument let's say someone invented a single pill that eliminated all cataracts (both current and future)... What would happen to the field of ophthalmology? Would it be possible to sustain a comprehensive practice or would this force everyone into a sub specialty? Clearly this will likely never happen but I was just trying to think of something interesting to debate while I await match day.

Would a ton of residency programs shut down?

Cataracts will probably disappear the day degenerative joint disease, menopause, presbycusis and senile dementia also disappear.

 

[dantt]

A more realistic scenario...

What will happen when lasers reduce cataract surgery to a skill-less procedure? (This is happening right now)

And just for kicks, what will happen when optometrists want to do these simple laser procedures?

 

[JMK2005]

What will happen when lasers reduce cataract surgery to a skill-less procedure? (This is happening right now)

You don't know what you're talking about.

 

[MNGradToBe12]

A more realistic scenario...

What will happen when lasers reduce cataract surgery to a skill-less procedure? (This is happening right now)

And just for kicks, what will happen when optometrists want to do these simple laser procedures?

Please. They'd probably just recommend Vision Therapy for them anyway.

 

[Shnurek]

Please. They'd probably just recommend Vision Therapy for them anyway.

Or talk therapy.

 

[Mirror Form]

A more realistic scenario...

What will happen when lasers reduce cataract surgery to a skill-less procedure? (This is happening right now)

And just for kicks, what will happen when optometrists want to do these simple laser procedures?

It's not like Medicaire (or any insurance plan for that matter) is going to pay thousands of extra dollars so that a patient can have cataract surgery performed much more slowly and less efficiently. And the femtosecond laser really only takes care of a couple steps (it does not remove the cataract). The procedure would still require quite a bit of skill.

 

[Mirror Form]

For the sake of argument let's say someone invented a single pill that eliminated all cataracts (both current and future)... What would happen to the field of ophthalmology? Would it be possible to sustain a comprehensive practice or would this force everyone into a sub specialty? Clearly this will likely never happen but I was just trying to think of something interesting to debate while I await match day.

Would a ton of residency programs shut down?

1. Cataract surgery is the most commonly performed surgery in the country and the world. If it disappeared, it would signficantly impact ophthalmology. That said, with the boomers hitting retirement, ophthalmologists are going to be very very busy even w/o cataract surgery. Residencies would not shut down.

2. Cataracts aren't going anywhere anytime soon. They're a natural part of aging. That's like a plastic surgeon being afraid that someone will magically make all wrinkles disappear with a pill.

 

[Visionary]

It's not like Medicaire (or any insurance plan for that matter) is going to pay thousands of extra dollars so that a patient can have cataract surgery performed much more slowly and less efficiently. And the femtosecond laser really only takes care of a couple steps (it does not remove the cataract). The procedure would still require quite a bit of skill.

Yeah, I just can't see this catching on. It's cute that they have figured out how to use the femtosecond laser to make corneal wounds, capsulorrhexis, and fragment the lens; however, these steps all have to be done in a separate room from the lens removal and IOL implantation steps. As you said, it's less efficient. If there was a dramatic improvement in outcome quality, such as from ECCE to phaco, I could potentially see it. There's simply not, and current phaco can be done safely by most experienced surgeons in 15 minutes or so. Then, there's the cost. If they made one device that could do refractive and cataract, maybe. The current device cannot do refractive. That means you need two femtosecond lasers! That would be cost-prohibitive. Won't be likely to get many people paying extra for it (like they do for premium IOLs), and insurance definitely won't bump reimbursements for it. It will hang around for the wow factor in a few academic centers, but that's it.

BTW, a recent study demonstrated no significant difference in outcomes between femtosecond laser-assisted and standard PK.