• Will You Miss Surgery?

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    There is probably nothing more satisfying than a well-done surgical procedure, both in terms of the pleasure in doing a precise job, and in the patient’s attitude and gratitude. There is probably no other specialty where the results of surgery are as palpable and visible and immediate.

    When I started to research this subject, I had never really asked anyone I knew how they felt about giving up — I felt that it was a private subject, and possibly upsetting or unwelcome as a topic. Low and behold when I started asking various colleagues about their feelings, the universal response was relief, 15 seconds of possible regret that was soon swept away by part-time medical ophthalmology or in a flurry of golf, tennis, traveling, seeing the grandchildren and a perceptibly lower stress level that they had never acknowledged while they were doing surgery.

    On a personal level, in 2002 after I finished a routine cataract procedure, I left the Manhattan Eye and Ear Hospital, and was walking toward Third Avenue, when I suddenly said, “That is the last case I will ever do.” It was as simple as that. I loved doing surgery — I had only two complications in all the years. I never thought about what it would be like to stop, but when I did, I was relieved and happily turned to assisting my associate Cheryl Kaufmann with all my cases. I didn’t know how I was going to handle telling patients that I was no longer doing surgery, but it went better than I had anticipated. I thought patients would be upset and reluctant to go to another doctor, but that proved to be my ego. As it turned out, when I added that I was assisting, that was that. I subsequently did all of the post-op care and felt that I got more credit than I did as a surgeon. And I love assisting (for free incidentally).

    To stop of your own free will before you lose your skill, or before people are thinking “Are they STILL operating?” is an art, I think. I also think subconsciously that I heard the message when several patients over time said, “Are you still operating?” And I took pride in saying “yes” without thinking what lay behind that innocuous question. The computer has sabotaged any effort you make to conceal your true age, but since I had gotten white hair in my late thirties, I had felt ageless.

    So I went from von Graefe’s knife, through intracaps, extracaps and phako and that covered a period in ophthalmology from 1956 to 2002. That was an extraordinary period in our field when technology became something to be proud of. I worked with Charlie Kelman when we were using the first phako machine at MEETH. And I am now seeing eye care changing in a dramatic way with the advent of Lucentis and Avastin.

    But all along I had another interest, which started at the same time as my residency. I was captivated by the idea of restoring vision to the visually impaired. It seemed to be an important part of our mission as eye care professionals to rehabilitate as well as operate. Over the years starting with the AAO Low Vision Committee and always seeing low vision patients in my practice one day a week, I have had more rewarding experiences than surgery ever provided.

    Recently I saw a 90-year-old lawyer from Georgia who is still working and active, but was frustrated with his inability to read print. His secretary had to waste hours typing up articles, briefs and letters in 22 point print. Glaucoma had destroyed his right eye, but the left had some vision, and moderately good contrast sensitivity. He was able to read a brief from his practice, and the newspaper with a good refraction correcting a considerable cylinder, and a special magnifying add of 8 diopters. He was dejected when he came in, and energized when he left. I quoted a refraction fee on his chart, and my secretary told me later that he said “nonsense” and doubled it.

    The Academy’s Vision Rehabilitation Committee is active and willing to help you do something to replace surgery that will also restore vision for your visually challenged patients. There are many distractions out there, but I think to transfer your skills within your practice from surgery to rehabilitation of another type, keeps you in the same groove of helping your patients.

    Give it some consideration. You can go to the Smartsight page and look into the ways that the Academy can help you get started with adding low vision to your practice.