Quality of Life & New Medical Technology


Dr. Lindsey Spencer
Curaçao Laser Institute

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The well-being or quality of life of a person is an important concern in economics and political science and consists of many components. Some, e.g. standard of living, income and access to goods and services, are fairly easily measured, in contrast to healthcare, where monetary measures do not apply.

The measures often used in the study of healthcare are “quality adjusted life years “ (QALYS ) or “disability-adjusted life years” (DALYS), both of which equal 1 for each year of full health life, and less than 1 for various degrees of illness or disability. Thus, the cost-effectiveness of a treatment can be assessed by the cost per QALY or DALY it produces; e.g. a cancer treatment which costs Naf. 10.000 and on average gives the patient two years extra of full health costs Naf. 5.000 per QALY.

Nowadays people associate high quality medicine with advanced medical technology. Ironically, medical technology is also blamed for contributing in a major way to the rising costs of healthcare. Innovation in medical technology was simpler in the beginning, e.g. the first pacemaker was developed by an electronics repairman in the 1950’s, three weeks after pioneering open-heart surgeon Walter Lillehei described to him what he had in mind. But the newest medical technologies can bring many benefits to patients, carers and clinicians. Medicine in turn has become more and more dependent on new medical technology for its clinical and prestige value.

The quality of life of the patient can be improved through more effective and efficient treatments, making remote diagnosis and treatment possible, reducing treatment times and hospitalization, etc. There are, however, limitations to the use of new technologies: they can be expensive, the patient (and clinician!) can find it difficult to use the new technology, there may be reduced human contact with the practitioner, etc.

Advanced medical technology can be found in all fields of medicine. Strong collaboration between medicine and biochemistry, physiology, physics, bioengineering and other disciplines is essential. In the specialization of radiology, for example, MRI and PET scans can “visualize” all parts of the inside of the body. Laparoscopic surgery is common in gynecology, urology and all kinds of surgery. Laser therapy plays an important role in ophthalmology, dermatology and surgery.

In my field, ophthalmology, common problems, like cataracts (opacification of the eye lens) and refractive errors, have experienced various developments recently that have improved the quality of life by increasing and saving sight. The eyes are considered “the windows to the world“, and of all the senses, the eye is considered the most important. If we have vision problems, they directly impact our quality of life.

Vision-threatening diseases like diabetes and glaucoma can be controlled with the newest drugs and lasers, thus decreasing the percentage of people suffering from blindness or severe visual handicaps.

The use of surgical microscopes, micro-surgical instruments and antibiotics make it possible to treat the most devastating conditions of diabetic retinopathy and glaucoma. Corneal transplantations have a higher success rate due to a lower percentage of rejections by e.g. better typing and matching of donor and recipient corneas, the use of newest available drugs, surgical methods, etc.

Cataract surgery has become an out-patient, no-stitch procedure, under local anesthesia, of less than 20 minutes! Surgery is performed with the newest equipment, so called phaco-aspiration machines that fragment the lens, with simultaneous insertion of a foldable intra-ocular lens through an incision of less than 3 mm! The aim of cataract surgery nowadays is not only to restore sight, but preferably without the use of glasses. Sophisticated devices to measure the power of the intra-ocular artificial lens have been developed and the newest lenses are already on the market, correcting distance and near vision, thus reducing (or eliminating) the use of glasses (of course, there is a price tag attached).

Today patients want to see better without glasses and/or contact lenses, marking the era of a new lifestyle. Refractive surgery with the Excimer laser can provide the solution. As a matter of fact: LASIK is the fastest growing medical procedure! With the LASIK or LASEK procedure, most eyes can be corrected to zero in less than 10 to 15 minutes by re-shaping the cornea and so creating a positive or negative lens! This all happens in the cornea, a structure with a median thickness of 540 micron (about 0.54 mm !), more or less the “windshield“ of the eye!

Before surgery, Topography (measurement of the curvature of the cornea, front and back!) and Pachymetry (to measure thickness) is done, with the newest equipment, developed with the help of physics and biomechanics. The newest Excimer lasers, like the Wavelight Allegretto, are functioning at even higher speeds and with more accuracy, thus making treatments not only faster, but also safer, and with the elimination of most side-effects.

Through its Perfect Pulse Technology, Wavelight has ensured that the entire treatment and each pulse of the laser beam are completely controlled. Environmental factors like humidity and temperature are eliminated, ultra fast eye-tracking devices follow the fastest eye movements precisely with the laser beam, and thermal effects on the eye and dryness are prevented.

Even hypermetropia (plus glasses) can be corrected in an accurate way. New software is under development, aiming at correcting both the far and near vision, thus eliminating the need for glasses entirely. Today, millions of people already enjoy independence from glasses and contact lenses, and an improved quality of life, thanks to refractive laser surgery. This all is possible by an extensive collaboration between medical doctors, engineers and mathematicians.

Therefore, in conclusion, it can be stated that advanced medical technology and quality of life are definitely attached to each other. Unfortunately there is a price tag involved. The question is: how far are we all, policy makers and people, willing to go and pay for this kind of care? Is the sky still the limit?