anterior segment specialization

[BUTTERCUP109]

I know many ophthalmologists call themselves "cataract and refractive surgeons", but I know there is no subspecialty credentialing in ophthalmology.  Is it fair to say that there is much diversity within those doctors that describe themselves in this way? ie.... Have some doctors have had a career as a LASIK surgeon with little cataract experience, while others have employed a mix of both in their practice, or even set themselves apart as primarily cataract surgeons?

[BUTTERCUP109]

Dr. Pernoud,
Perhaps you can comment on some thoughts I have on the subject of "anterior segment specialists".
Ophthalmologists who began to practice in the 80's, in the height of the explosion of interest in LASIK, were very possibly able to do this exclusively with advertising, etc. Such a doctor could line up dozens of patients on surgery days each week to have RK, PRK, LASIK, etc..Now, the demand is in decline and these doctors are doing more lens-based procedures to balance their practice...maybe, after decades of very little cataract surgery experience. Does any of this hold water?
I had Crystalens with such a doctor, I had a torn capsule, a posterior vitreous detachment coming very close to vitreous prolapse, retained lens fragments, and
ongoing problems with CME now two years post-op, despite treatment by the best retina doctor and the very best available drugs.  And, of course, no near or intermediate vision from the Crystalens, which was done as a clear lens exchange at age 48, purely for the accommodative benefit which I obviously forfeited at the hands of this doctor.

[Joan M Pernoud, MD]

Cataract removal is the primary procedure of all general ophthalmologists unless they specialize in a subspecialty like retina or neuro-ophthalmology, etc. Cataract extraction is the most common surgical procedure in the US under Medicare.

There are refractive fellowships at this time and corneal fellowships also can be LASIK related so there can be further training for LASIK but that is not a requirement as there are many continuing education opportunities for general ophthalmologists to become quite adept performing LASIK procedures. The overall number of LASIK procedures are still quite alot fewer than cataract surgeries and the majority of LASIK practice is driven by marketing whether in the ophthalmologic or optometric spheres.

Of course, cataract surgery can also be considered a refractive surgery since the refraction of the eye changes when a different, better lens implant power is placed in the eye or all the newer varients such as toric implants or multifocal implants are potentially placed.

I think you are correct that the description of "cataract and refractive surgeon" is a very diverse group.