The reality of modern ophthalmic practice has become increasingly stark as rising overhead collides with relentless cuts in reimbursement. The notion that we ophthalmologists can offset these shortfalls simply by becoming more efficient now borders on absurd; we have squeezed out every ounce of efficiency we can. Staff turnover following the COVID-19 pandemic only amplified the strain. This is not just an inconvenience but also a throughput issue that affects patient access across the entire refractive cataract market.
The only relief valve for practices offering cataract and refractive surgery has been premium IOLs, which have sustained profit margins while delivering tremendous value to patients, but I see storm clouds on the horizon. Multifocal optics have reached a plateau: They are good but not good enough to meet escalating demands. Earlier generations of patients tolerated imperfection. Today’s patients expect nothing less than perfection, and any perceived shortcoming can incite a backlash—not just in the examination lane but online. If manufacturers cannot deliver IOL technology that provides a continuous range of vision without the compromises of glare, halos, and diminished contrast sensitivity, multifocal IOLs may follow the path LASIK has taken in the court of public opinion. As a result, patient communication has become absolutely vital. I increasingly find myself leaning on tools—emerging AI among them—that may help me consistently set realistic patient expectations.
In this issue of CRST, our roundtable contributors tackle challenges spanning practice economics and staffing pressures, fellowship training value, ocular surface optimization, IOL selection strategies, and refractive decision-making algorithms, walking through the full spectrum of refractive cataract care with both honest assessments of where we stand and thoughtful approaches to moving forward.
Perhaps AI-driven patient education will help reset expectations to match current technological capabilities. Perhaps breakthrough accommodating IOL designs will finally arrive. What’s certain is that we must navigate these challenges while maintaining the standards of care our patients deserve—and that requires candid conversations about the realities we face.
