Purpose:

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

Methods:

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

Results:

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.

Conclusion:

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