05-EY-103* Eye and Vision Systematic Reviews.
There are a variety of eye diseases and disorders
that lead to visual impairments and blindness.
Eye Care Professionals are treating these disorders
with certain medications, surgery, or optical instruments or devices.
However, in many instances it is unclear how the strategies
compare with each other for improving and maintaining vision,
quality of life, and reducing health care costs.
Projects that answer this challenge would help health care providers
and patients make well-informed decisions about healthcare.
Contact: Dr. Don Everett, 301-451-2020, deverett@nei.nih.gov

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Dear Dr. Everett,

After 40 years of practicing ophthalmology I question
the utility - and wisdom - of cataract extraction in
a patient whose vision in the other eye is sufficient
to enable him - or her - safely to operate a motor vehicle 
and to read without undue effort. For the past several
decades I have advised my patients with cataracts,
which are often (much) more advanced in one eye than in the other,
to postpone surgery so long as they are able to drive
safely and to read comfortably with the better eye.
Pursuant to this advice, many of my patients have
lived comfortable and productive lives without ever
requiring cataract surgery in either eye.

In those instances where progression of the cataract
in the better eye makes the impairment of vision
functionally significant, i.e. interferes with the
patient's ability to drive safely or to read comfortably,
I have advised cataract surgery in the eye in which
the cataract is more dense.  When that initial operation
restores vision to a high level of acuity, as it usually
does, I routinely advise my patients that there is no
medical necessity for cataract surgery to the second eye;
and that the marginal functional benefit of cataract
surgery to the second eye, if it obtains at all, is so
limited as to be of no practical functional consequence.

Assuming that the advice which has been followed by many
of my patients, by members of my family, and by myself,
is valid, then if that advice were adopted as policy for
a program of national health insurance, the number of
cataract surgeries performed in the United States would
be reduced by more than fifty percent, with resultant very
substantial reductions in the cost of medical care.

I understand well that there are contravening considerations
for every issue; one can entertain arguments to the effect
that cataract surgery is beneficial even when the resulting
enhancement of visual function, where it occurs at all, is only
marginal.  But I understand also that professional practices
in contemporary surgical ophthalmology are driven not by
disinterested considerations of patients' benefits, but
by calculations of financial benefit to surgeons.
If the country cannot afford universal health care,
this is the case because for decades diagnostic and therapeutic
strategies have been designed by the purveyors of surgical
services, of pharmaceuticals and of medical instrumentation
to maximize their profits. I am prepared to try to help to
remedy this situation.

Ernst J. Meyer MD      Harvard College B.A. 1949    
174 School Street      Harvard Graduate School of Arts and Sciences M.A. 1950
Belmont MA 02478       Harvard Medical School 1954

617-484-8109
ernstmeyer@earthlink.net