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RevOpht Letter Get Rid of The Grid Oct2010
RevOpht Letter Get Rid of The Grid Oct2010
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REVIEW Letters
2. Crossland M, Rubin G. The Amsler chart: absence of evidence is not evidence of absence. Br J Ophthalmol 2007; 91:391-3. 3. Zaidi FH, Cheong-Leen R, Gair EJ, et al. The Amsler chart is of doubtful value in retinal screening for early laser therapy of subretinal membranes. The West London Survey. Eye (Lond) 2004; 18:503-8. 4. Schuchard RA. Validity and interpretation of Amsler grid reports. Arch Ophthalmol 1993; 111:776-80. 5. Loewenstein A. The significance of early detection of age-related macular degeneration: Richard & Hinda Rosenthal Foundation lecture, The Macula Society 29th annual meeting. Retina 2007; 27:873-8. 6. Goldstein M, Loewenstein A, Barak A, et al. Results of a multicenter clinical trial to evaluate the preferential hyperacuity perimeter for detection of age-related macular degeneration. Retina 2005; 25:296-303. 7. Loewenstein A, Malach R, Goldstein M, et al. Replacing the Amsler grid: A new method for monitoring patients with age-related macular degeneration. Ophthalmology 2003; 110:966-70. 8. Loewenstein A, Ferencz JR, Lang Y, et al. Toward earlier detection of choroidal neovascularization secondary to age-related macular degeneration: Multicenter evaluation of a preferential hyperacuity perimeter designed as a home device. Retina 2010; 30:1058-64.
surely tell 10. Though none of us may choose to like this age-old fact, we must all live with it. Keratorefractive and premium lens surgeries have been commoditized. We enjoy the benefits and must also suffer the inevitable consequences.
TO THE EDITOR: Reviews August article (ASCRS Members Are Getting Aggressive p. 70) discussing recent trends in keratorefractive and IOL surgeries was informative and well-timed. The mix of newer technologies combined with our wider body of experience clearly gives us the tools to bring safer and more effective treatment options to our patients. That backdrop combined with current economic realities provides a dynamic landscape where new boundaries are constantly being challenged. My disappointment with the article stems from the lack of common sense and perspective that the author shares with his readers. Lets start with his discussion about clear lens exchanges on presbyopic patients. He seems to convey some level of confusion about why surgeons are doing fewer of them. Later in his article, he relates his surprise regarding consumer response to bad press surrounding the LVC. It is evident this author-doctor has surely slept through Marketing 101. Lets review. A happy customer may tell a friend and an unhappy one will
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I recall a simpler time, not too long ago, when postop patient disappointment with phacoemulsification and single-vision lens implantation was extremely rare. These days, I am tempted to take a quick test peek into my exam room before committing to walking in to do my postop checkups.
With that out of the way, lets talk about the realities of LVC, premium IOLs and clear lens exchanges. As they are inherently elective and usually involve out-of-pocket expenditures, customers (a.k.a. patients) set their satisfaction bar very high. So high, in fact, that many surgeons understandably begin to back off after being worn down by seemingly relentless dissatisfied patients. We all know that patients considering these procedures seem to relentlessly include the term perfection when discussing their options. Who can blame them, we all want perfect eyes, especially when it costs a bundle to get them. I am a 58-year-old presbyope and I wonder how much confidence I would have to opt for a clear lens exchange. Im not there yet. And while were at it, how many ophthalmologists who are now in their 50s have had clear lens
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exchanges performed on themselves? The room is quiet. Is there anyone out there? I recall a simpler time, not too long ago, when postop patient disappointment with phacoemulsification and single-vision lens implantation was extremely rare. These days, I am tempted to take a quick test peek into my exam room before committing to walking in to do my postop check ups. Who knows, a shoe may come flying towards my head, and I fear that my reflexes may not be as good as our former presidents. These realities are all expressions of fundamental rules of marketing and human nature. Paying for something turns it into a commodity and, like it or not, expectations soar. To this point, I recall my recent dinner conversation with a highly acclaimed cataract surgeon, who had been a clinical investigator for a major premium IOL company. Elliot, I dont understand, he said, During the study, everybody loved them and once they started paying for them, the complaints started rolling in. Please understand, none of the cynicism that I convey should discount the elegance of this new generation of surgical refractive options. The options are amazing and are even more so when surgeons clearly understand and engage themselves in the sensitivities of their individual customers. The best surgeons use this understanding to optimize patient selection and outcomes. They meticulously individualize care, remembering that LVC and premium IOLs are not always the best option, remembering and adhering to the practices of delivering more than you promise and doing no harm. Those options will never burn you! Elliot M. Kirstein, OD, FAAO Cincinnati
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