Editorial: Future will require ophthalmologists to adapt

March 1, 2009

Ophthalmology is constantly evolving, and the ways things are done now are not necessarily going to stay the same in the future. The reality is that it's more important to be able to adapt to change than it is to predict change.

Key Points

As a medical student, I barely knew how to spell ophthalmology, and I didn't understand half of the research projects in which I was participating. That actually was a good thing, because those projects turned out to be either fruitless or wrong.

Change is a constant

The surgical techniques that I learned as a resident are not the ones that I perform now, new IOL designs provide better vision than ever before and go through smaller incisions, our phaco platforms allow an unprecedented level of safety and efficiency during surgery, and modern excimer and femtosecond lasers offer the highest degree of accuracy. The technology pipeline is full of even more bright ideas for future surgical procedures. I don't know exactly what cataract or refractive surgery will be like in the future, but I know that it'll be better and safer and that I'll enjoy performing it.

We're also in a time of economic uncertainty, which confounds the other unknowns that our profession faces. And again, there's virtually no way of accurately predicting just how things will turn out. What's the future of health-care reform? Will there be a national health plan, and how will ophthalmology fare? Will the impending fee cuts happen, and how will that affect access to health care? With fewer new ophthalmologists available to replace the retiring ones, will there be a shortage of surgeons to care for the baby boomers? I'm afraid that I have more questions than answers, but I know that the future will require us to adapt to change.

Look around the American Society of Cataract and Refractive Surgery (ASCRS) annual meeting and feel the energy: there are thousands of people and acres of exhibits, and all of them have a passion for cataract and refractive surgery. When the original surgeons started the predecessor to the ASCRS in Los Angeles a few decades ago, did they have any idea that it would grow to be such a large, powerful, and cohesive organization? Or did the founding surgeons simply follow their passions, embrace the uncertainty, and adapt to change?

At this year's ASCRS annual meeting, I'll see new technologies, instruments, and techniques. I'll learn surgical pearls from the leaders of our profession, and perhaps I'll even figure out how to decipher complex coding issues. I suspect that we'll see significant changes in the way that eye care is delivered, with more of an emphasis on team work. With no shortage of future patients, it means more and more people will receive the gift of sight through our surgeries. But most of all, I'll embrace my uncertain future, as long as it includes the art and magic of ocular surgery. Now if I could just figure out how to remove the cataract from my crystal ball . . .

Uday Devgan, MD, FACS, in private practice at the Maloney Vision Institute in Los Angeles, chief of ophthalmology at Olive View–UCLA Medical Center, and associate clinical professor at the University of California, Los Angeles, School of Medicine. He may be reached at devgan@ucla.edu
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