Prevention has always been the best way to maintain good health. Frequent doctor visits, preventative testing and early intervention has shown to reduce medical problems and in many cases mortality. For years that has been the mantra of the medical profession which has been supported by all the data and research. Why then did we all hear in November of 2009 that it is now being recommended that women start getting mammography’s AFTER the age of 50 instead of 40, get them every two years instead of one and NOT to do self breast exams.

The answer that we are being told is that the early and frequent procedures, which was detecting issues and leading to early treatment, may have also resulted in too many and in some cases unnecessary therapies. While I can understand not wanting treatments that are not required if the alternative is deaths because of undiagnosed cancer, most people will chose the procedures.

I believe that this has been pushed not by the medical needs of the patients, but by the insurance industry wanting to reduce its’ cash outlay. By pushing screenings back 10 years it would be able to substantially cut back on office visits, testing and surgeries that they now pay for. Even self breast exams that have no downside, can lead to a greater insurance pay out and thus they want to advise against them.

My suggestion is to always advise early detection, but be more careful on the therapy end. Perhaps follow cases more closely if there is a question whether treatment is needed, but always be ready to treat when needed. The alternative seems to be throwing the baby out with the bath water. It is despicable that the very lives of our loved ones are being sacrificed for the saving of money by insurance companies. The time has come for us to think with our heads not our wallets, and start using common sense which seems to be lacking in the insurance industry and many layers of government.

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The long term side effects of refractive surgery have been a concern for all patients and doctors alike. When Radial Keratotomy(RK) was being performed; there were many unknowns. Flattening the corneas with radial corneal incisions stretched the endothelial layer decreasing its’ ability to pump water out of the cornea. While most RK surgeons were not worried about the long term corneal hydration, questions did remain as to what would occur years after the procedure.

These RK patients do have corneal issues 10 plus years later. Their corneas often display a brownish line in the bottom half indicating iron left behind when the endothelial pump removes fluid from the cornea. In addition, most of these patients are far sighted with astigmatism and their prescription gets stronger later in the day. This makes it difficult to have an accurate eye glass prescription. Weakness of the cornea also increases the risk of corneal rupture when exposed to trauma.

LASIK and PRK do not flatten out the entire width of the cornea thus leaving the endothelial layer intact. This does not affect the pump or the functioning of the physiology of the corneal tissue. Therefore negative corneal changes that are displayed in RK patients should not occur in the LASIK and PRK patients.

According to an article published in the November issue of the Archives of Ophthalmology, there are no long term destructive corneal effects following LASIK and PRK. The study examined 29 myopic LASIK and PRK patients 9 years after the surgery and found them to display no abnormal changes. There was a 5.3% decrease in the endothelial cell density which corresponds to a normal cell decrease in individuals that never had the refractive procedure.

While the study did not examine far sighted post operative patients, they concluded that the results would be similar to the near sighted patients. Whereas post operative RK patients displayed corneal changes after 5 years, the LASIK and PRK patients did not show any signs after 9 years. Further studies must be conducted at longer post op intervals to fully examine the long term effects, but this initial study is very encouraging.

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