Eyeworld

76 | EYEWORLD | SPRING 2025 C ORNEA by Julie Schallhorn, MD Cornea Editor T he articles in this is- sue's Cornea section focus on challenging situations in cornea and the tools that we have to address them. Every one of us has been there—sitting across from a patient, looking at them, and knowing that what is best for their condition is not something that they're going to want to hear. From recommend- ing a monofocal over a multifocal in a patient who wants to be free of glasses to advising a patient that they need to have their eyelids (re- versibly or irreversibly) stitched shut, these are the difficult conversations that we all dread. In a healthcare environment that increas- ingly rewards efficient, routine care over complex cases, taking the time to sit down with a patient and share a difficult decision with them is under pressure. With Medicare cuts and the onerous demands of private insurance, the needs of patients who have complex conditions are at risk of getting overridden in the name of efficiency. Taking the time to see a patient who needs a higher level of care, let alone having the difficult discussion about intervention, is increasingly becoming a luxury. As physicians, it is in our very being to provide the best care for every patient who comes through our clinic. In the case of patients in need of more complex care, this naturally entails a more detailed discussion with them, and a greater investment of time to build the patient-physician relationship. Unfortunately, our current reimbursement system is placing this under stress. Do we simply decide to refer these pa- tients away to a tertiary care center where time and resources are seemingly more abundant? Unfortunately, larger medical centers are also under strain from the same forces, an effect that I am currently very acutely feeling in my own university practice. At what point does our duty to care for patients translate into advocacy for our profession? This is the question I ponder when I sit down and recommend a BrightMEM anterior keratoplasty, a corneal transplant in addition to cataract surgery, or a tarsorrhaphy. In this issue, Albert Cheung, MD, Rajan Shukla, and Joseph Tauber, MD, discuss BrightMEM as a treatment option for ocular surface disease. On the topic of opacified corneas and the problems they can present for patients in need of cataract surgery, David R. Hardten, MD, Kevin M. Miller, MD, and Zeba A. Syed, MD, weigh in with how they handle these patients. And Christopher R. Dermarkarian, MD, Kourtney Houser, MD, D. Brian Kim, MD, and Christopher Rapuano, MD, discuss using tarsorrhaphy. For these complex patients, I do my best to be present with them and to help them understand this process. What I fail to under- stand is why this is increasingly undervalued in our society. Sometimes the hard choice is the right one Taking the time to see a patient who needs a higher level of care, let alone having the difficult discussion about intervention, is increasingly becoming a luxury. Chris Ketcherside, MD, EyeWorld Cornea Editorial Board member, shared what he is excited for at the ASCRS Annual Meeting: "The ASCRS Annual Meeting is the perfect mix of true learning, networking, traveling, and building lifelong friendships. I am always humbled by what transpires, and I absolutely look forward to it every year!" ASCRS ANNUAL MEETING P R E V I E W

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