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Many ophthalmic nurses enjoy that new technologies are continually being developed, so there is always something new to learn and improvements to be made.

When Penny Gold, RN, was working in the operating room years ago, she traded off with other nurses to avoid ophthalmologic cases. Then, an eye surgeon approached her and offered to teach her the field if she would work for him. She's now been in ophthalmology for more than 20 years.

"This is a field where you won't be bored; there is a lot to learn. It is very rewarding," said Gold, now OR supervisor at Southwestern Eye Center in Mesa, Ariz., a multispecialty, statewide practice performing all kinds of eye surgeries.

Students have little exposure to ophthalmology in nursing school or even after, and nurses who work in the field say those outside of it may know little about it or think it uninteresting. But those who do enter the field tend to stay.

"This is an incredibly exciting field to work in," said Jane Katzen, RN, director of refractive surgical services at Katzen Eye Care & Laser Center in Florida. "It gives you a tremendous degree of satisfaction to improve or return the miracle of sight."

Vision is precious to patients, for one thing. Gold has seen patients with more fear about a procedure on their eyes than they had about heart surgery. For another, doctors of ophthalmology can identify many health problems, and many diseases have complications that involve the eyes. Patients come from all walks of life and all age groups. No two days are ever the same.

"Leonardo da Vinci said about the eye, 'Who would believe that so small a space could contain the images of all the universe?' " said Victoria Navarro, MSN, RN, director of nursing at The Wilmer Eye Institute at Johns Hopkins. "The eye is a complex organ and there are many subspecialties within ophthalmology."

Many nurses enjoy that new technologies are continually being developed, so there is always something new to learn and improvements to be made. Cataract surgery, for example, used to be an inpatient procedure involving a stay in the hospital, sandbags to immobilize a patient's head postsurgery and eye patches. Today, patients walk out after a quick outpatient laser surgery, already with better vision. That kind of immediate result can be gratifying for a nurse, Gold said.

Degree of influence

Laser technology means ophthalmic procedures are quicker and less invasive. Outcomes are generally improved. Most procedures are done on an outpatient basis. Yet nurses are needed more than ever-to assess patients, provide pre- and postoperative instructions, perform diagnostic tests, give medications and counsel patients. They save physicians time and improve continuity of care. In freestanding surgery centers, nurses are often largely responsible for the safeguards that ensure that everything is being done correctly.

"Even though laser surgery is a safe and effective procedure, I want patients to understand there are still risks associated with it," said Jean Hill, MSN, RN, CRNO, nurse supervisor at the University of Iowa Hospitals and Clinics' Department of Opthalmology & Visual Sciences. "I don't think any of our doctors want a patient to be taken lightly."

Rapid growth in the number of freestanding clinics, many of them devoted primarily to Lasik (laser in-situ keratomileusis) vision correction, creates some concern among ophthalmology nurses. Because this procedure is an elective one, paid for out of the patient's pocket, centers are competing in ways that seem more suitable to consumer products than medical procedures. That makes many nurses uncomfortable.

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