A philosophy of managing eye disease in an epoch of disruption

Change is the only constant. Oh, how it irks us!

In his book, “Reflections on the Psalms,” C.S. Lewis opines about time:

“Hence our hope finally to emerge, if not altogether from time (that might not suit our humanity) at any rate from the tyranny, the unilinear poverty, of time, to ride it not to be ridden by it, and so to cure that always aching wound (‘the wound man was born for’) which mere succession and mutability inflict on us, almost equally when we are happy and when we are unhappy. For we are so little reconciled to time that we are even astonished at it. ‘How he’s grown!’ we exclaim, ‘How time flies!’ as though the universal form of our experience were again and again a novelty. It is as strange as if a fish were repeatedly surprised at the wetness of water. And that would be strange indeed: unless of course the fish were destined to become, one day, a land animal.”

CHANGING WITH THE TIMES

To come to accept change and begin to, of a sort, “ride time” and not be ridden by it, our philosophy about managing eye disease must also change. All of us are victims of our training. Even intuitive surgeons are conservative by nature, and we struggle when new technology emerges because of the always aching wound that “mutability inflicts on us.”

To riff off the fighter jet cover art on this issue, we must train for the unexpected disruption in our jet stream. We must get comfortable with being uncomfortable. It’s not about us. It’s about giving our patients the best we can with what is available — not with what we happen to have been trained to do, what the FDA indication is or what is on the shelf at the clinic or hospital at which we serve.

IN THIS ISSUE

This month, we are pleased to touch on some new and better ways to treat glaucoma, cataracts and other eye disease.

We talk about ASC efficiency with leading experts, to improve the patient experience and maximize the number of those we serve with limited resources — the most limited of which is time. We discuss new technology that is available to cataract surgeons that improves patient safety and outcomes. We review major advances in infection control through the use of intracameral antibiotics. We demonstrate how to adopt sustained-release glaucoma medications. We discuss a major disruption in the postoperative management of eye surgery and glaucoma with the use of compounded fixed combinations of topical steroids, NSAIDS and antibiotics, as well as glaucoma drops. There are significant advantages to these drops — not only for our patients but also to the practice of medicine in an era of shrinking reimbursement.

Finally, we held a roundtable discussion that highlights, in a practical and courageous fashion, this philosophy of managing eye disease during an epoch of disruption. This is the art of individualizing eye care by treating the people behind the eyeballs in our exam chairs.

You may not like change, but it is our reality. To quote Dr. Charles Kelman, the father of modern cataract surgery, “While doctors debate, patients decide.” OM

Steven R. Sarkisian, Jr., MD, is a fellowship trained glaucoma, cataract and anterior segment surgeon, former professor of ophthalmology and glaucoma director, and is the founder and CEO of Oklahoma Eye Surgeons, PLLC in Oklahoma City. Dr. Sarkisian is on the editorial board of numerous journals, including the Journal of Cataract and Refractive Surgery, and has co-authored the book, “Minimially Invasive Glaucoma Surgery, A Practical Guide.”

Disclosures: Dr. Sarkisian reports relationships with Aerie, Alcon, Allergan, Bausch + Lomb, Beaver-Visitec International, Glaukos, Katena, MST, New World Medical, Ocular Science, Santen and Sight Sciences