R
Contact
information
Chang:
dchang@empireeyeandlaser.com
Donnenfeld:
ericdonnenfeld@gmail.com
Maloney: rm@maloneyshamie.
com
Solomon:
Kerry.solomon@carolinaeyecare.
com
Thompson:
vance.thompson@vancethomp-
sonvision.com
Vukich:
javukich@gmail.com
Waring:
georgewaringiv@gmail.com
Wiley:
drwiley@clevelandeyeclinic.com
you're trying to make the judgement, is it really
doing anything—they're seeing 20/20, maybe
it's affecting their image quality a little bit, and
they have a multifocal implant—and you're just
wondering will this refractive endpoint with the
capsulotomy, we'll do those capsulotomies for
nothing, they're part of the package. The only
time we charge for a capsulotomy is when it
meets the visual criteria.
Dr. Chang: We should probably not put a ther-
apeutic capsulotomy into a refractive package
because it could be argued that you're charging
cash for a Medicare-covered service. But there
is no Medicare coverage for a refractive capsu-
lotomy, so you can put your own price for that
or package that in.
Dr. Thompson: I think that as you peel back
the onion and get into refractive cataract
surgery, this is a delicate timepoint. When it
is capsulotomy time, I ask the patient, how are
we doing for joy? If they're not very happy, I
know residual refractive error is going to be re-
Premium Cataract Surgery:
ally important. If I do a capsulotomy, it's going
to be a lot tougher to do an IOL exchange. I
will say that, as we all know, IOL exchanges are
a lot less likely with modern-day technology,
but when I get to that 3-month timepoint and
we're thinking about a fine tune and we're doing
a refraction and they're kind of wishing their
image quality was just a little bit better, and I'm
starting to see a little PCO, and we know the
technology that splits light, anything else that
splits light, like dry eye, epithelial issues, or
residual refractive error, PCO, we need to take
care of. But if they're not close to joy, I'm not
doing a capsulotomy until they really under-
stand that means an IOL exchange is more dif-
ficult and carries higher risk, if an exchange is
needed. This is an important part of informed
consent and the patient really appreciates know-
ing this.
Editors' note: This roundtable discussion began in the
September issue and will conclude in the next issue of
EyeWorld.
Robert Maloney, MD
Relevant financial
interests
Chang: Johnson & Johnson,
Carl Zeiss Meditec
Donnenfeld: Alcon, Allergan,
Johnson & Johnson, Novartis,
Carl Zeiss Meditec
Maloney: None
Solomon: Alcon, Allergan, Bausch
+ Lomb, Johnson & Johsnon
Vision, Carl Zeiss Meditec
Thompson: Alcon, Johnson &
Johnson Vision, Bausch + Lomb,
Mynosys
Vukich: Johnson & Johnson
Vision, Carl Zeiss Meditec
Waring: None
Wiley: RX Sight, Alcon, Bausch
+ Lomb, Johnson & Johnson,
Carl Zeiss Meditec
NOVEMBER 2019 | EYEWORLD | 33
