Report of some common attitudes in medical retinal practice with multiple IVTs, issues pertaining to high risk of over-standardization, lower necessity of an expert medical advice and short-time possibilities of low-cost evolution excluding ophthalmologists


Protocols with IVTs required for AMD or ME treatments are analysed and we have pointed out several medical contestations of these protocols.


Nowadays protocols with IVTs for AMD or ME tend to over-standardize multiple IVTs and automatic decision-making to re-injection, mainly based on OCT imaging. Both protocols and OCTs give false sense of security, linked to our numbers dependence, acting like a true drug addiction. Overtreatments become usual, potentially linked with immediate money profit, but a mediocre medical reflection. Several typical examples show interest of non-systematic IVTs re-injection protocols and advantages of keeping a semiological approach. It is compared to usual guidelines in retinal practice for AMD or ME. These guidelines are associated with a high risk of increase -in a first step- number of non-retinal specialists performing IVTs and follow-up for maculopathies. The second potential step is risk exclusion of ophthalmologists, and we present some consistent modelling for that.


Evidence of past economic models in other domains showed that competition should increase quickly in retinal medical practice with value of each IVT decreased. The price of exams for follow-up should follow this « low-cost » future. Payment of all of this depends to public healthcare system and/or private insurances, depending of country. It is already a huge total cost for so many treated patients and so much repetitive exams, and it should dramatically increase with time. Performing it without changing all the system of payment and/or partners is an economic dead-end. IVT is a very easy treatment which could be done by a nurse, and retinal imaging improvements with OCTs lead to possibility of « Fordism » follow-up which could be done by optometrists, orthoptists or technicians. This convergence is a real Trojan horse for beginning a new sharing-economy in ophthalmology. Everything could change in a very short-time for ophthalmologists in a bad way, except if we keep medicine practice as an art, complex but human, still difficult for a non retinal specialist, and impossible for a non medical Practitioner. This is a potential « special extra-value » for those remaining retina surgeons which have continued to do true vitreo-retinal surgery and semiological medicine, rather than to inject everyone and everything.

Contact Details:

Email: hamonpro@gmail.com
Cell Phone: +33607486707

Frederic Hamon