By the age of 6 years, I knew that I wanted to become a medical doctor. I believe many colleagues in our field must have had similar feelings in their childhood. Throughout high school, my plans to study medicine remained unaltered.
After graduating from university, I vacillated between becoming a plastic/reconstructive surgeon or an ophthalmologist. Because each specialty offered the opportunity of performing microsurgery, I was equally attracted to both. In the end, the cosmetic aspect of the routine practice of a plastic/reconstructive surgeon did not appeal to me.
In January 1990, I joined a group ophthalmology practice in Zwolle, Netherlands. Soon after, I began to subspecialize in cataract surgery, and in 1992 I readily transitioned from extracapsular surgery to phacoemulsification. As one of the early adopters of foldable IOLs, I began receiving invitations to make presentations at meetings, and before long I became one of the opinion leaders in cataract surgery in my country.
In the same period of the early 1990s, excimer laser refractive surgery was also rapidly developing. Virtually all my fellow cataract surgery subspecialists in my age group started private practices in laser refractive surgery.
Everybody expected me to do the same, and I was even offered an excimer laser, completely free for a period of 6 months, to build a practice without any investment risk. I turned down this generous offer, which left several people shocked and disappointed. They simply could not understand why I refused the offer.
Why did I continue to focus on traditional cataract surgery?
RESTORING VISION
The first—and most important—reason for this was that the thought of cutting into healthy tissue has always frightened me. I feel comfortable doing surgery in eyes with conditions that would otherwise deteriorate. Restoring vision to a patient is a gratifying part of this profession. Solving challenging or complicated cases, which are frequently referred to me by colleagues, is also extremely rewarding.
The challenge of operating on complicated cases increases my energy level to withstand the everyday pressures of a busy, high-volume cataract/IOL practice.
A second reason I stay away from refractive/cosmetic surgery is that I do not enjoy dealing with the sometimes unrealistic demands of refractive clients.
A third reason is that I have been able to dedicate time and energy to a number of research and development projects in cataract instrumentation and IOL systems without being distracted by refractive nightmare cases and business problems.
But what about the future?
REFRACTIVE CATARACT SURGERY
Fifteen to 20 years ago, a patient's visual acuity had to be reduced significantly by the cataract before we would decide to operate. There is a definite trend today toward earlier surgical intervention. This trend can be explained by the continually improved visual outcomes of cataract surgery and the low incidence of complications.
In recent years, multifocal and toric IOLs have become available, and patient satisfaction is generally high with these premium lens options. The availability of presbyopia-correcting IOLs opens up a new potential patient group: presbyopes with little or hardly any cataract.
It is no longer uncommon to be confronted by a 55-year-old who has talked to a happy friend or relative with a multifocal IOL and wants the same. These people typically search the Internet carefully for information on presbyopia correction and come to the conclusion that they want a near-clear lens extraction and a presbyopia-correcting IOL.
In fact, we have entered into a new era of refractive lens surgery, with a great deal of overlap between traditional cataract surgery and traditional refractive surgery. Refractive lens surgery will likely grow quickly and soon become an everyday part of our ophthalmic practices.
But what about myself as a traditional cataract surgeon?
I believe that inevitably all cataract surgeons will adapt themselves to this new era of better informed patients with higher demands similar to refractive patients. I will probably follow the same track and team up with the refractive subspecialists in my group.
I have also noticed that, for many of the same reasons, traditional refractive surgeons have increasingly regained interest in the latest lens removal technologies.
Khiun F. Tjia, MD, is an Anterior Segment Specialist at the Isala Clinics, in Zwolle, Netherlands. Dr. Tjia is the Co-Chief Medical Editor of CRST Europe. He states that he is a research consultant to Alcon Laboratories, Inc., and Hoya. Dr. Tjia may be reached at e-mail: kftjia@planet.nl.
