The line between therapeutic vigilance and financial over-treatment is becoming increasingly blurred.
Honesty is at the heart of medicine. Yet, in modern ophthalmic practice honesty is increasingly competing with profit - and too often profit is winning.
Patients automatically told they need intravitreal injections for the rest of their lives - or it just happens to never stop.
Not because their condition is active and not because fluid or hemorrhage has recurred - but because someone has decided maintenance therapy forever is the standard of care.
Patients being led to assume lifetime injections are necessary to prevent recurrence and keep their vision. Is this truth or convenient rationalization? Do certain doctors actually have a supernatural ability to predict the future?
Consider schools of thought…
Maintenance Approach - Injections indefinitely regardless of clinical status.
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Justification: Prevent recurrence before it happens.
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Reality: Years of injections with no measurable benefit - only burden.
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Outcome: Around 2K USD per injection.
Treat-and-Extend Approach - Indicated treatment guided by clinically significant activity.
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Justification: Treat when necessary - extend when stable.
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Reality: Fewer injections and fewer risks while showing empathy and respect for the patient - a real human being.
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Outcome: No more 2K USD per injection - but patient trust and loyalty forever.
Both philosophies exist under the banner of patient care, however, could it be possible the motivation is very different?
We must ask ourselves if some of our colleagues, consciously or not, have convinced themselves endless injections equals ethical care.
I want to believe most physicians mean well, but as this pattern is spreading (at least from my vantage), the damage to patient trust and the integrity of what we do is immeasurable. Because patients are catching on. How do I know? Because I see them in my practice all too often. I then explain reality with objective proof - and we have an honest talk.
Our duty is to practice with honesty and empathy. We must treat people as we would treat ourselves, our friends, or our family. It’s just so very simple.
What is honesty?
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Reassessing the necessity of every injection - even if you’re not physically performing it.
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Communicating risks, benefits, and alternatives.
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Educating less treatment does not mean less care.
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Respecting patient autonomy, understanding what that means, and practicing it.
Because…NO ONE has a monopoly on knowledge or clinical acumen.
Have you seen similar patterns in your practice? What are you doing about it?
đź’¬ Comment or share your perspective - your honesty may help someone else rediscover theirs.
- John R. Martinelli, MD, OD, FAAO
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