A close friend wanted to refer his coworker to me for an ophthalmic condition that needed treatment. I first asked him what type of ocular problem his friend was having because, since I specialize in cataract and refractive surgery, I tend to focus on those patients in my practice. He said that the friend was told by his local optometrist that it was some sort of retina problem. I replied that it would be better for me to kindly decline and instead offer the name of a trusted retinal colleague.
My friend was flabbergasted that I don’t “do the whole eye.” To an outsider, it was apparently incomprehensible that I would specialize in just the anterior segment of such a small organ. He figured that since the eyes are 2 small things the size of walnuts, how hard could it be to treat the whole eye? I thought to myself, “You’d be surprised!”
I divide my week between my private practice, which is a mix of cataract surgery, LASIK, and other refractive procedures, and teaching my ophthalmology residents at a large county hospital where we cover the full spectrum of ophthalmology. My experience with a recent patient with bilateral neovascular glaucoma caused by uncontrolled diabetes illustrates it best: in one sitting we did the anti-VEGF injection, the cataract removal, panretinal photocoagulation with the indirect laser, lens implant insertion, and finally placement of a glaucoma tube shunt device. In the private practice world of a large city, this would have been split among 3 different ophthalmologists: a general ophthalmologist, a vitreo-retinal surgeon, and a glaucoma specialist.
I particularly enjoy my time in this busy county hospital clinic because it allows me to see the full spectrum of ophthalmic disease. We had more than a dozen patients last year with ocular syphilis, something that I have never seen in 2 decades of private practice. I’m comfortable doing and teaching retinal laser and injection procedures, simple strabismus and lid surgery, and managing many aspects of glaucoma, uveitis, cornea, and other conditions. I recognize that I do not bring world-class expertise in these areas, but I am capable and enthusiastic about helping our underserved population.
In smaller towns across the United States, there are many ophthalmologists who maintain their skills across many subspecialties of ophthalmology. For example, you simply cannot expect to have a neuro-ophthalmologist in every town coast to coast. I am humbled when I think of the challenge that a general ophthalmologist faces in a small town, where every patient who walks in the door requires treatment and you cannot simply rely on being able to refer to subspecialists.
The knowledge base across ophthalmology has grown tremendously in the past couple of decades. We now must master a far larger encyclopedia of knowledge during the same 3-year residency, and perhaps a move to 4 years is imminent. Our residents are truly amazing, and I am in awe when I see just how much material they learn in all specialties during the 3 short years.
To the ophthalmologists who treat the full spectrum of ocular conditions, I salute you and I try my best to emulate you when I’m at our academic-affiliated county hospital. And to the specialists who are so plentiful in Los Angeles, I thank you for helping me with these patients who are outside of my area of expertise. And as far as the aformentioned patient goes, I am grateful that a colleague is treating his multiple evanescent white dot syndrome. But I would be happy to see the patient in the future should he need cataract surgery!