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Today's Practice | May 2009

5 Questions With Francesco Carones, MD

1. Why did you decide to become an ophthalmologist?
I was reluctant to commit to ophthalmology while I was in medical school because my father was an ophthalmologist and I did not want to pursue the same specialty as he. I originally wanted to be a cardiac surgeon, but I quickly realized I was not comfortable seeing so much blood. When my father invited me to watch him operate, I decided that I was better suited to performing ocular surgery. I like that all of the procedures are done with microscopes, produce little blood, and are generally minimally invasive. I now consider my father to be my mentor.

2. How is your practice different from those in the United States?
Practices in the United States, especially laser vision centers, are much larger than those in Europe, and they often focus on treating a high volume of patients. I deliberately keep my practice small because I prefer to provide a few patients with high-quality care. I currently perform approximately 800 laser procedures and 300 intraocular surgeries every year.

My refractive surgery patients tend to be older than those in the United States. Rather than doing laser vision correction on 25-year-olds, I tend to perform refractive lens exchanges on 45- to 48-year-olds who are on the edge of, or already have, presbyopia. I currently implant premium IOLs in approximately 50% of my patients who undergo intraocular surgery because these lenses allow me to address refractive errors and presbyopia at the same time.

Finally, because I am not allowed to advertise in Italy, approximately 95% of my referrals come from people I have treated. This kind of internal marketing fits my desire to build one-on-one relationships with my patients and helps me consistently provide high-quality care. My services are expensive, so I want patients to feel they get the care they expect.

3. How do you use phakic IOLs in your practice?
I implant phakic IOLs in patients who have more than 8.00 D of myopia. These individuals are not good candidates for LASIK because they often complain about problems with night vision postoperatively. Phakic IOLs can correct high degrees of myopia and still provide excellent visual quality, especially at night.

Of the eight phakic IOLs approved for clinical use in Europe, my current favorites are the AcrySof Phakic Lens (Alcon Laboratories, Inc., Fort Worth, Texas), the iris claw-fixated Artisan, and the foldable iris claw-fixated Artiflex (both from Ophthec BV, Groningen, Netherlands). All of these lenses have large optical plates that do not induce halos or cause problems with night vision. Patients appreciate that I can easily remove the lenses if something goes wrong.

Of course, I carefully screen patients preoperatively with Scheimpflug photography and anterior segment OCT to make sure their anterior chambers are large enough to accommodate a phakic IOL. These technologies also help me detect iris bombe and identify patients who might develop a chronic inflammatory reaction to phakic IOLs.

4. How is your practice weathering the global financial crisis?
I think my practice is doing a lot better than others that are dedicated to offering lower-cost procedures to a larger population of patients. Patients are willing to spend more money to see me because they know I will personally oversee their care from the preoperative consultation through the final postoperative evaluation.

Although I performed 30% fewer purely refractive procedures in 2008 than I did in the previous 2 years, my volume of cataract and intraocular surgeries (including the implantation of phakic IOLs) increased by 20% during the same period. I therefore estimate that the overall volume of procedures in my practice has decreased by 10% in the past 2 years.

5. What is your favorite leisure activity?
Unlike many of my colleagues, I do not like to play golf. I prefer to go sailing and SCUBA diving. I especially like to dive at night because I feel like I am visiting a different world. I enjoy the calm, relaxing environment; the fish are less active, and it is easier to touch them. I think the best place to dive is in the Maldives, a group of atolls in the Indian Ocean off the coast of India.

I also spend a lot of time with my daughters. I feel like they are my future. When they grow up, I want them to remember all of the fun we had together when they were little.