EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/111385
72 EW RESIDENTS February 2013 Informed continued from page 70 I briefly go over the procedure. They need to go home with someone the day of the surgery. They need to lie flat for up to an hour. They will be aware of touch or pressure, but no pain. Anesthesia will be tailored to the individual patient. We will do what is necessary to make the surgical outcome successful. I make a small cut 1/7 of an inch and through here open the capsule or skin of the lens. I vacuum the lens out with ultrasound, not laser. I put a plastic implant to help focus the light. Patients will take drops for a month, and I need to see them one day, week, and month after surgery. A prescription for new glasses will be given at one month. Resolving the indication for surgery is the benefit. Benefits can include less reliance on glasses. They will be a safer driver, be able to do their needlepoint again, read the opera subtitles, etc. I tailor this to the patient. Expectations include what they will see after surgery and need for glasses. After surgery the patient may be 20/20 yet be very unhappy. It is also important to give thought as to where you will leave the patient: plano with OTC readers or myopic in order to read without glasses. Maybe you left a myope plano and they can���t see their cell phone without readers. Specifically tell patients what they will need glasses for after surgery. Often we will do surgery on someone who has had multiple retinal procedures. There is a reasonable assessment that they won���t be 20/20, but clearly will be helped by the surgery. The PAM, laser interferometry, or dilated pinhole may help with the prediction. There are other special situations, such as nanophthalmos, with increased risk of complications. In these situations I start out by saying, ���You don���t have a normal eye.��� That does not mean that they won���t see better, but you want to make sure they understand that they are not average. I touch on four categories for risks. There may be a need for more surgery for a variety of reasons (droopy lid, some of the lens might not be removed during the first surgery, etc.). Infection occurs up to 1 out of 500 that requires an injection of antibiotics, as the drops were not sufficient. This may leave the patient with less than ideal vision due to scarring from the infection. The eye can react to the surgery, even when done perfectly, and prevent good vision. (I am referring to CME. It occurs 1 out of 200, but 85% get better.) I tell the patient this occurs 1 out of 1,000. There is always a worstcase scenario for everything in life and fortunately it is very rare. This includes loss of the eye from a severe infection, uncontrolled eye pressure, or something that cannot be helped despite our efforts. What I do promise is to take care of the patient. At the end, I mention that I work with residents and I make sure patients are aware that they will be doing part of the surgery. It is easier for me to address this, but some of my residents will tell my patients themselves. Patients are often perfectly comfortable with them at the end of this consent process and give permission. I then ask patients if they have any questions. It is ultimately all about trust. I find when my residents go over the consent process with a pre-op patient, the patient gains a lot of trust in them. This process is surprisingly efficient and the time spent with a good consent pays off in the long run. On the day of surgery, the patients often don���t have questions as these issues have already been explained. EW continued on page 75