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Evolving with Technology
BY SUSAN J. TAUB, MD, FACS

In eye care, in which the speed and leaps of technological advancement are fast and dramatic, it's always a challenge to imagine today's technology in the practice of the future. But when it comes to three of today's most significant new technologies -- wavefront correction, multifocal intraocular lenses and silicone hydrogel contact lenses -- I'm confident in saying that not only will they be part of any future practice, but you should make them part of today's practice also.

I've embraced all three of these new technologies in my practice because I feel I must. Even more important than being on the cutting edge of what's new today, I need to be prepared for what will be cutting edge a few years from now. The only way to do that adequately is to stay abreast of advances in technology.

Imagine the refractive surgeons who said to themselves, "I'm going to sit out this LASIK phase because I'm sure something better will come along." They guessed correctly that the technology would evolve. However, while they were waiting, their colleagues were happy to provide LASIK services to patients.

Or imagine contact lens practitioners who thought disposable contact lenses were too frivolous to bother with. We can't sit idly by waiting for the next evolutionary wrinkle. We lose credibility with our patients, and we rob them of the chance to try what's best right now.

Finding a Place Today

Each of the three refractive treatment options I mentioned has a place in today's practice, even if none is perfect. We can't pre-select what a patient will want, so we must present our recommendations and help guide patients to the option best suited for them. We can do so with integrity by pointing out where new technology is better than its predecessors and where the shortcomings are.

For example, wavefront correction has its strength in better vision. We will perfect it as we better understand aberration. I've found that emerging presbyopes and hyperopes are most interested in learning about this new technology.

Many cataract patients have a prime interest in multifocal IOLs. My typical cataract patient is between 55 and 70 years old.

However, not everyone wants or is suitable for refractive surgery, and that's where silicone hydrogel contact lenses come into play. A greater oxygen flow to the cornea is beneficial, making hyper-Dk silicone hydrogels the premier lenses for any contact lens patient and any wearing schedule. As the material becomes available in more lens designs, its appeal will increase. Further evolutions in the lens material or design will result in greater applications and increased patient acceptance.

Don't Give Up

But here's where waiting for the next evolution proves problematic: Let's say that some of your patients report mild lid sensation during the first few days of wearing silicone hydrogel lenses. Do you change to another modality prematurely, quite often while the cornea is rehabilitating from years of chronic edema?

With this approach, the biggest risk is that many of your patients could go elsewhere to gain the significant clinical and convenience advantages of silicone hydrogels. So I recommend the lenses to appropriate candidates and let them decide. If they prefer their former lenses after one month of wear, then I'll accept it because they've given the new technology a fair chance. But when the next evolution comes, I'll have more credibility when I explain how the new technology is better than what came before.

Eye care is constantly evolving. As practitioners, we must do the same.

Dr. Taub is president of Taub Eye Center in Chicago, IL. She's also an assistant professor at Northwestern University, Department of Ophthalmology, in Chicago.