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Up Front | Jun 2010

CHIEF MEDICAL EDITOR’S PAGE: Pushing Boundaries in Economic Hard Times

Greetings from the United Kingdom, where we managed to get a coalition government sorted in record time that will undoubtedly expedite changes to ensure we all tighten our belts. Throughout Europe, there are problems of similar magnitude, in particular in Portugal, Ireland, Greece, and Spain, and with bailouts that have ramifications for other European Union members, including Germany.

Will all this fallout compound our current problems arising from the recession? In a word, the answer is yes. However, it does not have to be a situation that breaks the ophthalmic market. In this issue, Arthur Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Ed); Ed Toland BSc, MBA; and Wolf Eckhard Weingaertner, MD, FEBO, provide insight and pointers on how to preserve a successful practice in the downturned economy. Practicing our trade to a high standard and behaving above reproach is vital to maintain our reputation.

Word of mouth will always be a major component of referral for the readership of this publication. Dr. Cummings' approach to less-than-ethical advertising demonstrates integrity and optimizes what initially might be seen as adverse. The commercial chain in question has pulled the advertisement as result of a ruling from the Advertising Standards Authority. In the February 2010 issue of CRST Europe, we published an article on EUCOMED and self-regulation (Medical Technology Collaboration: Getting the Balance Right, pages 70-72). Sadly, not all ophthalmic manufacturers are signatories, and perhaps this is an area in which we as purchasers have some power to ensure compliance, especially in this new world of increased transparency and close scrutiny of the pharmaceutical and medical industries.

In hard times, as business decreases, there is motivation to add streams of revenue or perhaps push boundaries for treatment. John S. M. Chang, MD, describes femtosecond complications, and although they occur less frequently than complications with microkeratomes, it is crucial to devise a plan of management for thin-flap LASIK complications. The reasons to perform thin flaps are both biomechanical as well as practical, because it provides greater inclusion of patients. Mirko R. Jankov II, MD, PhD; Vesna Jovanovic, MD, MS; and Efekan Coskunseven, MD, contribute to this issue with a reminder of what to do after suction loss in LASIK.

Hard times also fuel innovation. In this edition, Michael A. Lawless MA, MBBS, FRANZCO, FRACS, FRCOphth, provides the case for performing surface ablation in patients with keratoconus. He combines these treatments with corneal collagen crosslinking (CXL). In my large referral practice, I have been referred eight patients with ectasia following surface ablation on forme fruste keratoconus (an article I have yet to publish). Mean age at surgery was 34 years (range, 29–40 years), and mean spherical equivalent of treatment was -4.00 D. Most important, mean duration to presentation was 2.7 years (range, 4 months to 9 years). Perhaps the addition of CXL might have avoided ectasia; however, long-term data are required.

Interest in visual rehabilitation in keratoconus is increasing and will be the subject of an issue of CRST Europe later this year. An alternative for visual rehabilitation in this context that is available to us in Europe is the reversible Toric ICL (STAAR Surgical, Monrovia, California) or the Artiflex Toric (Ophtec BV, Groningen, Netherlands). Data are accumulating to demonstrate phenomenal levels of visual acuity following the procedure, which is best suited for those with fairly good BCVA.

Pearls for correction of astigmatism are provided by Maria Clara Arbalaez, MD; Thomas Magnago, Dipl-Ing; and Bruce Allan, MD, FRCS, exploring the options of excimer and solid state lasers. Rounding out this cover focus is a series of articles on avoiding and handling surgical complications. These contributions by Richard E. Braunstein, MD, and Anne S. Steiner, MD; Jorge L. Alió, MD, PhD, David P. Pinero, MD, and Miguel A. Teus, MD, PhD; and Marguerite B. McDonald, MD, are useful in both reinforcing what we know and providing interesting new approaches in handling patients whom we might consider at the boundaries of correction.

Finally, it is a pleasure to welcome my friend, Erik L. Mertens, MD, FEBOphth, as Co-Chief Medical Editor to CRST Europe. Erik embraces technology with intimate knowledge of both cataract and refractive surgery.

Success to you all in these less-than-ideal economic times.