Perfect Surgical Outcomes Erode Relationships

Eye Drops for Macular Degeneration
March 1, 2010
Mr. Ozurdex's Vision is Sustained
March 3, 2010
Show all

Perfect Surgical Outcomes Erode Relationships

If surgical outcomes were successful each and every time, would a doctor need to talk to a patient?

Surgical outcomes are never guaranteed, there are risks to surgery.  In fact, nothing in medicine is guaranteed.  One role of doctors is to educate about the benefits and potential risks of a treatment.  On the other hand, if an operation, were successful every time, would we need doctors?

Starting Your Car is Guaranteed

Each time you turn the ignition, your car starts.  It is just about guaranteed.  The outcome is so successful, we have lost an understanding of automobile mechanics (yet in doing so we have become pretty sophisticated in understanding car warranties).  When you buy a car, do you ever question how often the car will start?

Eye Surgery Works Like a Car

Now let’s turn to surgical outcomes.  What if eye surgery were successful each and every time?  By successful I mean each patient saw better immediately after surgery and there were no complications from the surgery.  Each surgical outcome was successful.

If eye surgery were as successful as a car starting; we wouldn’t need discussions about possible complications of surgery, nor would we need counseling about possible visual outcomes after surgery.

Eye surgery would be risk free.  There would be benefits and no need to counsel about possible risks.  Would we need docs?

Cataract Surgery is Intuitive and Highly Successful

The technical complication rate of cataract surgery is somewhere around < 0.1%, that is, rarely are there problems with removing a cataract and inserting an implant.  Visual outcomes in cataract are very high and, for the sake of this article, most patients see better after cataract surgery.

Cataract surgery is also intuitive.  You have an operation and you see better.   “Successful” cataract surgery means improved vsion.

There Are No Blogs About Cataract Surgery

Patients with retinal disease, such as diabetic reitnopathy and macular degeneration, have non-intuitive eye problems.  There are fairly complex discussions that each individual must face.  Hence, the success of this blog is based upon the complexity and confusion of having retinal disease.

Cataract surgery, by comparison, has far fewer variables and takes less understanding.  It takes less counseling.  There aren’t many reasons to have a web-based information site, because almost all the time, surgery is “successful.”

What Does This Mean? I say this all the time.  “If something were successful all of the time, a doctor would never have to speak to a patient.”

Cataract surgery and retinal disease are at opposite ends of the spectrum.  Chances are you know more about cataract surgery than you do about retinal disease.

Retinal disease is pretty complex, the vision is often compromised and the surgical outcomes are somewhat “blurry.”

It is pretty disheartening for a patient to undergo a retinal operation, eye injections, laser, etc. and be left with decreased vision, yet the procedure has been deemed “successful.”

Keeping a patient’s perspective optimistic despite vision loss can be trying.  I have found the best way for patients to accept their outcomes is by giving them truthful knowledge, and if we are lucky, an understanding about their disease.  Hence, a reason for this blog.

“Randy”

Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

Comments
  • Bill Levinson March 27, 2011 at 3:08 pm

    I recently had successful surgery for a macular hole (fully closed). Unfortunately, a consequence of the surgery was a condition of having water under the retina. This results in cloudy vision. My doctor and I are looking for people who have experienced this condition (not seen, normally) to determine the best way to treat it. Currently we are using a “wait and see” approach. Anyone have suggestions? wjl

    • Randall V. Wong, M.D. March 29, 2011 at 2:42 pm

      Dear Bill,

      Other than having a retinal detachment, I don’t know about the “water under the retina.”

      Perhaps you could ask for a different explanation and send it my way?

      Randy

  • Post a comment