A Cataract might appear insignificant,
but it’s definitely not.

“Gathering extensive patient information through discussions and medical history analysis significantly enhances the treatment process, leading to optimal surgical outcomes.”

Naturally, our eyes experience a gradual decline in function as we grow older. Among the elderly population, common culprits of visual impairment are glaucoma and cataracts. Thanks to modern medical advancements, cataract surgery featuring the placement of intraocular lenses guarantees the restoration of clear vision for patients.

Today, we talk with Assoc. Prof. Dr Visanee Tantisevi (Dr A), an ophthalmologist, or “eye doctor”, with over 20 years of experience in glaucoma, cataract and intraocular lens placement surgery. Her secret is “rhetorical skills”. It is a fact that doctors have to communicate with their patients. However, why do ophthalmologists need to focus more on communication in particular? Let’s find out.

“Ouch! Can't stand it! Terrifying, something sharp is approaching my eye.”

The above sentence may reflect what many medical students felt when witnessing the first eye surgery; the same went for Dr. A. Back then, despite having less time to experience what it is like to be an ophthalmologist compared to other specialties, she firmly set her sight to be an ophthalmology resident due to her love for well-organized workflow, working in the ICU and the atmosphere of an operating room.

“Becoming an ophthalmologist feels like entering an entirely different realm. The terminology, acronyms, and disease names can seem foreign, akin to an alien language. We employ an array of specialized instruments. Due to the diminutive size of the eyes, standard medical tools might fall short of conveying what would happen to the patients. Witnessing eye surgery for the first time can be unsettling for those unfamiliar with the operating room. However, I embraced a gradual approach and found solace in performing microsurgery, a fulfilling pursuit that met my aspirations.”

A clear vision for the long journey

Dr A was born and raised in Bangkok and is familiar with Sukhumvit Road and Phra Ram 4 area in particular. She grew up in this area and has seen the changes and development of this neighborhood since she was young. After graduating, she becomes a dentist and resides in the capital city. It wasn’t until she heard that a new private hospital was going to be constructed that she envisioned long-term sustainability. 

“Is there going to be a hospital here? It would be convenient to commute. The hospital is in an emerging business district. It has a clear target group. Once I knew the management team members, I felt it was quite a big team, and there was no limit to keep them from advancing. This means a long-term sustainability.”

Dr. A, invited by her respected professor to join the MedPark ophthalmology team, paid a visit during the construction phase, and by working here now, she is even more confident that this hospital can grow by leaps and bounds long into the future.

“I had the chance to visit even before the walls were up. I could see the view of the lake, Benjakiti Park, and the bend of the Chao Phraya River. When I started working here, it turned out to be much more comfortable than I had anticipated. The state-of-the-art equipment and modern technology used for diagnostics and treatment are complete. There will be further advancements in the future, which we will keep ourselves constantly updated. Most importantly, the team is amazing; we have experienced nurses dedicated to helping patients and supporting us.”

Ophthalmologists must speak softly and kindly.

Assoc. Prof. Dr. Visinee is an ophthalmologic subspecialist in glaucoma and cornea. She has treated numerous patients. Beyond her medical knowledge and expertise, she is always mindful of effective communication. Ambiguous and incomplete information can impact a patient's decision to undergo treatment. In addition, her words need to be soothing. During eye surgery, most patients are not under anesthesia, which means they can hear various sounds around them. 

“For those who prefer to shout or speak loudly, if you aspire to become an eye doctor, you must adjust your mindset. During surgery on the eye, the patient remains conscious and aware, so effective communication with nurses or patients is crucial. Therefore, the tone must be gentle, soothing, and composed, devoid of sudden shifts. Humor can alleviate tension, and most importantly, emotional self-control is paramount. It is about having a resilient spirit. We strive to communicate with patients, offering them maximum reassurance. Entering an operating room is stressful for the patients. Effective communication contributes to a smoother experience overall.”

Patients and Doctors Collaborating for Treatment:

“Consider the example of a cataract; it might appear to be a simple condition, but it is not. Nowadays, artificial lenses offer various options tailored to patient lifestyles. However, it is not just a matter of choosing any lens type. If patients have other concurrent conditions, we must carefully consider and provide information about the most suitable type of artificial lens.”

Dr. A provides insights into treating cataracts and glaucoma, highlighting that, ultimately, patients design their treatment. Thus, gathering medical history, engaging in conversations with patients, and gathering as much information as possible contribute positively to the treatment process. Specific details about the individual medical history play a vital role. For instance, if there are pre-existing eye issues due to diabetes or age-related macular degeneration impacting certain parts of the eye's function, careful consideration is essential to achieve the most suitable surgical outcome for the patient.

“Another example is if you had Lasik surgery before and later developed a cataract or glaucoma, the treatment will be different as the eyeball is no longer natural. The structure of the eye may slightly change, namely, with a thinner cornea. Corneal curvature may also change. For cataract surgery, certain technology helps us get more accurate IOL calculations. As for the types of IOL, however, we must also consider the patient vision requirements.”

Doctors Guiding the Way:

The role of ophthalmologists involves guiding patients. They explain the options for improving vision or maintaining eye health, including discussing various methods, choices available, treatment duration, and any limitations. Recommendations are made based on reasons, suggesting which path is most suitable for the patient at that moment in time.

“When it comes time for cataract surgery, some patients wish for the best possible artificial lens. We can provide that if the IOL is right for their eye conditions. However, for patients with underlying conditions that might impose restrictions, we provide information to choose an artificial lens best suited to the specific preexisting condition and severity. Similarly, for glaucoma, treatment options include laser, medication, or surgery. Some prefer medication before surgical intervention, while others desire immediate laser treatment. Some dislike the idea of daily eye drops and wish for surgery. While surgery is an option, we must make the patient understand that surgery is not a one-off procedure, as glaucoma is a chronic condition. Regardless of the treatment, regular follow-ups are crucial to managing the condition effectively.”

Assoc. Prof. Dr. Visanee often finds that patients do not understand the treatment process and assume surgery is a cure-all, end-all treatment. In reality, patients must keep returning to see the ophthalmologist, and the treatment process has its timeline. In simple terms, it is akin to a chronic condition. We must control or avoid risk factors that can lead to the recurrence. If patients do not manage this on their own, they end up returning to the doctor. Dr. A shares a case of a patient who was reluctant to continue treatment.

“There was a patient with phthisis bulbi. One eye is affected by vision loss, while the other can only see just a little beam of light. She was once diagnosed with glaucoma. However, upon reexamination, she has a hereditary form of retinal degeneration. There is no treatment for it yet. Her retina will degenerate gradually. She may have been affected from a young age. Some patients cannot come to terms with the fact that their retinas will keep deteriorating.” 

“We understand that it is hard to accept. The patients need encouragement. Some may need to consult a retina specialist to understand their eye disorders. Some refuse to receive treatment due to their personal belief. The ophthalmologists may or may not be able to change their minds. In that case, we must provide patients with comprehensive, standard information.”

However, many elderly individuals avoid seeing a doctor out of concern for burdening their children or grandchildren. The ophthalmologists cannot help but regret that they could have helped patients more if patients had come to them earlier. After reading up to this point, you might want to look at the elderly members of your household and ask when their last eye check-up was. Can they still see you clearly, or if their vision already becomes blurry? Try your rhetorical skills and encourage them to visit an ophthalmologist.