Bring together two renowned refractive surgeons, the editor of Ophthalmology Times Europe and a relaxing drink in the beautiful setting of Monte Carlo and you have all the ingredients necessary for a lively, informative and entertaining discussion on the state of refractive surgery today. These two Italian surgeons, Roberto Pinelli and Paolo Fazio, it would appear have a plan — to change the way the world views refractive surgery.

What's the problem

Since the introduction of surgical refractive correction in the 1970s, its popularity has soared. The original radial keratotomy technique was manually demanding and performed in a standard operating room, thus it was mainly trained surgeons that offered this treatment to eligible patients. With the advent of excimer surgery things changed: along with the traditional group of surgeons and other very fine laser surgeons that pioneered refractive surgery in Italy, a new generation of commercially oriented ophthalmic practices began offering refractive surgery at lower prices in order to attract the highest number of patients. However, this has invariably lead to a greater emphasis being placed on quantity of patients treated rather than quality of treatment. Worryingly, some of the surgeons offering the new excimer technology had not been specifically trained in refractive surgery.

"Some years ago, Italy experienced a crisis in refractive surgery. It seemed at one point that every doctor was able to perform some form of refractive surgery. This happened because often a company would knock on a doctor's door and ask if they were interested in performing refractive surgery. If the doctor answered yes, but was uncertain because of his/her lack of knowledge, the company would offer reassurance by explaining that the procedure was very simple and one could be taught very easily," said Pinelli.

Roberto Pinelli, MD is Scientific Director of the Istituto Laser Microchirurgia Oculare (ILMO) in Brescia, Italy. He may be contacted by email: pinelli@ilmo.it

Although, luckily, many doctors were able to perform refractive surgery well, inevitably a greater incidence of complications resulted and the word began to spread that refractive surgery itself was unsafe. Naturally, confidence in the procedure fell and the Italian market suffered.

"Because of this, experienced surgeons committed to refractive surgery had to work very hard to rebuild and instill confidence in refractive surgery. We had to do things much better than before to regain that lost trust. Suddenly standards were raised, in the best interest of the patient, and we began to see improvements in the technology available to us. Today, for surgeons such as myself who truly believe in refractive surgery, we now have lasers and procedures that we can offer to satisfy even the most demanding patient," said Fazio. According to Pinelli and Fazio, the biggest obstacle in improving the quality of refractive surgery lies in convincing those who want to improve their practice that it is a three-stage process. "Performing refractive surgery is not simple, but it is only one part of the process. Good pre- and postoperative support is just as important but is often neglected," said Fazio.

It is this way of thinking that Pinelli and Fazio want to encourage. Building patient trust and confidence is of paramount importance and it is for this reason that they are spearheading an educational campaign in the form of their newly founded society.

"I woke one morning and shouted I want to start a society, to which my wife promptly responded, You are crazy! Now, with Paolo by my side, she thinks we are both crazy!" enthused Pinelli.

Our baby is born

And so, from this vision, the Italian Refractive Surgery Society (SICR; Societ�taliana di Chirurgia Refrattiva) was born in 2004. Very much in its infancy, but with almost 70 members signed up, the educational crusade has begun.