Outlook

Future recommendations to patients with ametropia would suggest the following: Until the age of 22 disposable contact lenses, then LASIK surgery, and with 45 years glasses or a re-operation to handle presbyopia. Children with strong refractive effects could already undergo Refractive Surgery at any age, if they do suffer from the prosthetic device. In very high myopia a intra-corneal lens (ICL) can replace LASIK surgery. ICL justifies for correction of myopia above 20 diopters, with increasing perfection ICL might take the place of LASIK surgery for myopia above 15 diopters.

However, the success and the acceptance of Refractive Surgery will depend whether the ophthalmologic community is determined to employ highest possible quality standards. Any half-hearted project will suffer from imperfections and damage the overall reputation of Refractive Surgery. LASIK surgery itself is rather simple compared to other surgical techniques, however, surgeons must be aware that this selective surgery does not allow defects. Therefore it can not be tolerated that surgeons wanting to do LASIK surgery do not undergo a special training with hundred's of pig eyes, before they start practising on human eyes. Of course, a lot of surgeries will be fine without training. However, the surgeon is then responsible for all defects which have been due to missing training. An integrated training program will be essential to control the success of Refractive Surgery.

Besides, the need of best skilled surgeons the presurgical selection is a challenge in itself: Only "good candidates" are to be scheduled. However, with today's typical relationship between patients and medical institutions not many of the "good candidates" will be left on the day of surgery.

The developed Total Quality System of LASIK with its best practise pattern is a solution to ensure that the benefits of Refractive Surgery become reality.

The developed procedure model for applying Total Quality Management in Refractive Surgery can be used to apply Total Quality Management in all fields of ambulant medical service. Some adjustments might be necessary to apply this procedure to stationary medical service. However, the Model of Meyer should become the standard tool for quality management in medical service and take the place of the Model of Donabedian. True quality characteristics defined by patients assure a patient perspective when analysing the medical service.

Applying TQM in ambulant medical care, using the developed procedure, greatly improves the quality, reduces costs and even improves the satisfaction of the patient and the service provider.