MAR 2014

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 122 of 210

E W FEATURE 120 "Ethically, they should perform it and absorb the additional costs," he said. D r. Miller said one issue that arises is that under Medicare, you can't just pay for the femtosec- ond laser because you want it. "Medicare's guiding principle is the 'golden knife' principle," he said. "You can't charge a patient more just because you use a golden knife to make your incisions." hear their colleagues saying, and their overall gut reaction to femto," Dr. Banja said. W hen physicians don't provide femto D espite the growing interest in the femtosecond laser, not everyone is using this technology just yet. If the patient is interested in the femtosec- ond laser but it is not provided by the physician, Dr. Hoffman thinks that it is the physician's responsibil- ity to explain the possible benefits and additional costs to the patient. I f the femtosecond laser is the choice for the surgery, physicians could then suggest a surgeon who is using that technology, he said. "At present, an ethical ophthal- mologist can only respond as he or she honestly sees femto playing out," Dr. Banja said. "If the doctor doesn't provide femto, he or she s hould inform the patient of that if the patient requests that technol- ogy." He also noted that if the oph- thalmologist believes that femto doesn't make a significant difference in cataract outcomes or won't make a significant difference for a given patient, this should be explained to the patient who inquires about it. "The interesting ethical ques- tion would be if the ophthalmolo- gist had come to believe that femto outcomes are substantially better than using a freehand technique but he didn't offer femto," he said. This could lead to a "struggle of con- science" for the physician who may not be offering what he's coming to think should be the "standard of care." What to ethically present Dr. Banja thinks that the best ethical justification for using femtosecond laser technology is if it's used to fos- ter the patient's benefit or for the sake of the patient. "Ethical behav- ior is always other-directed, not self- interested," he said. "Consequently, if a physician withholds or distorts a piece of information, it should be for very compelling patient-centered reasons. And even then, the physi- cian should think twice before doing it." EW Editors' note: Drs. Hoffman, Miller, and Banja have no financial interests related to this article. Contact information Banja: jbanja@emory.edu Hoffman: rshoffman@finemd.com Miller: kmiller@ucla.edu February 2011 WOC2016 February 5-9 Guadalajara, Mexico Host: Mexican Society of Ophthalmology Co-host: Pan-American Association of Ophthalmology WOC2016 and WOC2018 World Ophthalmology Congress ® of the International Council of Ophthalmology Say "¡Hola!" to Mexico and Spain WOC2018 June 16–20 Barcelona, Spain Host: Spanish Society of Ophthalmology (Sociedad Española de Oftalmología) Ethical continued from page 120 He said that so far, the major benefit that has been seen with the femtosecond laser is safety. Less phaco energy is expected and the capsulorhexis is rounder. But you w on't get paid more for doing a safer procedure, he said. Dr. Banja said there are several fundamental questions about the overall utility of femtosecond laser technology. The physician needs to determine how much benefit should be present to justify using the femto laser versus the manual procedure, what is the actual bene- f it, and how likely it is that the ben- efit of the femto laser would be different from a standard procedure. These questions also need certain data and research. "Until we have that data, I think the femto contro- versy will continue because oph- thalmologists will only use their anecdotal experience, what they 108-125 Feature_EW March 2014-DL2_Layout 1 3/6/14 3:59 PM Page 120

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