Risk benefit

At home or at work, ophthalmologists must decide what is an 
acceptable level of risk. Leigh Spielberg MD reports

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What is the risk-benefit trade off for a particular situation? That seems to be the primary question in my life these days, wherever I am and whatever I’m doing. The question poses itself when I’m in the clinic. It’s in the back of my mind in the operating room. It is a recurring theme when I’m at home with my kids. It pops into my mind when I’m doing any of my hobbies. In the clinic, I can usually manage the question quite well. Most of the surgical indications are fortunately quite straightforward, so the risk of operating is usually clearly outweighed by the expected benefits. But what about vitreous floaters in a middle-aged phakic patient with -5D myopia? Is the decision to operate too risky? Who’s to say? Similarly, in the operating room, almost every step of a vitrectomy is the result of calculating the risk. How closely should I shave the vitreous in this eye to make sure enough is removed but not so much that I risk an iatrogenic retinal tear. How much peripheral laser do I apply? Just a little, to absolutely minimise the risk of macular pucker, or a bit more, to allow me to sleep better at night, knowing that a micro-tear won’t end up as a retinal detachment. Do I suture the sclerotomies, with the knowledge that sutures can irritate for days to weeks, or do I risk the potentially dangerous but very unlikely postoperative hypotony? METAL OR PLASTIC? The risk-benefit calculations continue at home too. Do I allow my little chefs-in-the-making use a metal knife to slice a banana for breakfast? Or do I insist on them using a plastic kid’s knife? Can Philippa (5 years old) and Raphael be trusted with metal scissors? Ocular trauma, whether personal or professional, gives me nightmares. And, on a less serious and dangerous note, can I accept the risk of them dropping my (wife’s) iPad while they watch a video that keeps them busy long enough to allow me to finish writing this article? My hobbies all pose some level of risk. Do I always have to protect my big camera and its fancy lenses if it not only decreases the chance of an expensive fall but also the chance of capturing that perfect shot? A nasty fall off my mountain bike could result in a broken hand or wrist, with serious implications for my operating future. But riding ultra-cautiously somewhat defeats the purpose of riding at all. Is riding a motorcycle an acceptable risk for someone with a wife and two young children? Clearly, not if it’s rush-hour and raining. But what if I only ride down country roads on sunny Sunday afternoons? I’ve made it to where I am now, so I guess I’ll continue as I’ve done since day one. Dr Leigh Spielberg is a vitreoretinal and cataract surgeon at Ghent University Hospital in Belgium *This article was first published on 
www.eurotimes.org in March 2017